Name,

Address

Phone, Mobile, Email if available

Date of birth (needed by the chambre d’hote).

I eat:

Fish: Yes/No  Meat Yes/No

Dietary needs / Other special needs / requests

Are you a driver and are willing to drive in France:

YES/NO

Driving licence number:

Willing to drive 9 seater people carrier?: YES/NO

Insurance details

I already have or will obtain insurance when booking is confirmed and agree to take responsibility for my own safety on the event.

Signed……………………………

Workshop offers

Deposit enclosed (£90 - please make cheques out to Ian Williams):

____________________________________

Been on an Ian/Murrough overseas trip before? Y/N 

£_________

Signed:

________________________