Customer Booking Form (on Website)

This form should only be used to book a course and date advertised via our website www.pyb.co.uk and where online booking is not possible.
CHOSEN DETAILS:
TITLE OF COURSE*
COURSE START DATE*

DayMonthYear
Date
PLEASE CHOOSE BETWEEN THE FOLLOWING:*

NON RESIDENTIALRESIDENTIAL with SHARED ACCOMMODATION)RESIDENTIAL with SINGLE ACCOMMODATION (Subject to availability, Additional charge per night)
Amount of Attendees:*
Mountain Training/British Cycling Number (If Applicable)
PERSONAL DETAILS:
LEAD BOOKER*

First NameLast Name
DATE OF BIRTH*

DayMonthYear
Date
ADDRESS*
POSTCODE*
TELEPHONE*
EMAIL*
example@example.com
MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY*
ADDITIONAL BOOKING DETAILS:
SPECIAL DIETARY REQUIREMENTS*
MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS*
In the Unlikely Event of an Evacuation Do You Require Any Assistance?:*
I WISH TO SHARE A ROOM WITH: *
(We try to meet these requests but can not guarantee to do so)
NAME OF EMERGENCY CONTACT*
PHONE NUMBER OF EMERGENCY CONTACT*
ATTENDEE #2 PERSONAL DETAILS:
ATTENDEE #2

First NameLast Name
ATTENDEE #2 DATE OF BIRTH*

DayMonthYear
Date
ATTENDEE #2 ADDRESS
ATTENDEE #2 POSTCODE
ATTENDEE #2 TELEPHONE
ATTENDEE #2 EMAIL
example@example.com
ATTENDEE #2 MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
ATTENDEE #2 AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ATTENDEE #2 ADDITIONAL BOOKING DETAILS:
ATTENDEE #2 SPECIAL DIETARY REQUIREMENTS
ATTENDEE #2 MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS
ATTENDEE #2 In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
ATTENDEE #2 I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
ATTENDEE #2 NAME OF EMERGENCY CONTACT*
ATTENDEE #2 PHONE NUMBER OF EMERGENCY CONTACT*
ATTENDEE #3 PERSONAL DETAILS:
ATTENDEE #3

First NameLast Name
ATTENDEE #3 DATE OF BIRTH*

DayMonthYear
Date
ATTENDEE #3 ADDRESS
ATTENDEE #3 POSTCODE
ATTENDEE #3 TELEPHONE
ATTENDEE #3 EMAIL
example@example.com
ATTENDEE #3 MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
ATTENDEE #3 AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ATTENDEE #3ADDITIONAL BOOKING DETAILS:
ATTENDEE #3 SPECIAL DIETARY REQUIREMENTS
ATTENDEE #3 MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS
ATTENDEE #3 In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
ATTENDEE #3 I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
ATTENDEE #3 NAME OF EMERGENCY CONTACT*
ATTENDEE #3 PHONE NUMBER OF EMERGENCY CONTACT*
ATTENDEE #4 PERSONAL DETAILS:
ATTENDEE #4

First NameLast Name
ATTENDEE #4 DATE OF BIRTH*

DayMonthYear
Date
ATTENDEE #4 ADDRESS
ATTENDEE #4 POSTCODE
ATTENDEE #4 TELEPHONE
ATTENDEE #4 EMAIL
example@example.com
ATTENDEE #4 MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
ATTENDEE #4 AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ATTENDEE #4 ADDITIONAL BOOKING DETAILS:
ATTENDEE #4 SPECIAL DIETARY REQUIREMENTS
ATTENDEE #4 MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS
ATTENDEE #4 In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
ATTENDEE #4 I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
ATTENDEE #4 NAME OF EMERGENCY CONTACT*
ATTENDEE #4 PHONE NUMBER OF EMERGENCY CONTACT*
ATTENDEE #5 PERSONAL DETAILS:
ATTENDEE #5

First NameLast Name
ATTENDEE #5 DATE OF BIRTH*

DayMonthYear
Date
ATTENDEE #5 ADDRESS
ATTENDEE #5 POSTCODE
ATTENDEE #5 TELEPHONE
ATTENDEE #5 EMAIL
example@example.com
ATTENDEE #5 MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
ATTENDEE #5 AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ATTENDEE #5 ADDITIONAL BOOKING DETAILS:
ATTENDEE #5 SPECIAL DIETARY REQUIREMENTS
ATTENDEE #5 MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS
ATTENDEE #5 In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
ATTENDEE #5 I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
ATTENDEE #5 NAME OF EMERGENCY CONTACT*
ATTENDEE #5 PHONE NUMBER OF EMERGENCY CONTACT*
ATTENDEE #6 PERSONAL DETAILS:
ATTENDEE #6

First NameLast Name
ATTENDEE #6 DATE OF BIRTH*

DayMonthYear
Date
ATTENDEE #6 ADDRESS
ATTENDEE #6 POSTCODE
ATTENDEE #6 TELEPHONE
ATTENDEE #6 EMAIL
example@example.com
ATTENDEE #6 MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
ATTENDEE #6 AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ATTENDEE #6 ADDITIONAL BOOKING DETAILS:
ATTENDEE #6 SPECIAL DIETARY REQUIREMENTS
ATTENDEE #6 MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS
ATTENDEE #6 In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
ATTENDEE #6 I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
ATTENDEE #6 NAME OF EMERGENCY CONTACT*
ATTENDEE #6 PHONE NUMBER OF EMERGENCY CONTACT*
PAYMENT
The balance of your course fee is due 10 weeks before the start of your course.
The full fee of my course is £blanks
I am paying...*

Full Course Fee (If booking is within 10 weeks)25% deposit (non-refundable)
Select Payment Method*
NOTES i.e. discount code:
Do you have a PYB Membership

No, not yet.Yes, I have a Bronze MembershipYes, I have a Silver MembershipYes, I have a Gold Membership
Please tick the relevant box:

BY DEBIT/CREDIT CARD - On completion of this form, one of our team will contact you to take paymentBY BANK TRANSFER (BACS) - On receipt of the form our bank details will be emailed to youBY PURCHASE ORDER - For courses more than 6 weeks away please complete and return the booking form with a purchase order for the full amount.Other
Discount Code?
Please type your offer code in the box above.
Total payment
We recommend that you take out insurance including cancellation insurance.
INVOICING ADDRESS

PURCHASE ORDER NUMBER

INVOICING EMAIL ADDRESS

BUILDING NUMBER/NAMECITY

POSTCODE
NOTES:
Additional information
Would you like to receive offers, updates, info and more from us at PYB? (Don't worry we will not share your info with external/associated companies)

Yes PleaseNo Thank you
BOOKING DATE

MonthDayYear
Date
I HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS THAT RELATE TO THIS BOOKING.
SIGNATURE

Clear
Should be Empty:

CHOSEN DETAILS:

PERSONAL DETAILS:

ADDITIONAL BOOKING DETAILS:

ATTENDEE #2 PERSONAL DETAILS:

ATTENDEE #2 ADDITIONAL BOOKING DETAILS:

ATTENDEE #3 PERSONAL DETAILS:

ATTENDEE #3ADDITIONAL BOOKING DETAILS:

ATTENDEE #4 PERSONAL DETAILS:

ATTENDEE #4 ADDITIONAL BOOKING DETAILS:

ATTENDEE #5 PERSONAL DETAILS:

ATTENDEE #5 ADDITIONAL BOOKING DETAILS:

ATTENDEE #6 PERSONAL DETAILS:

ATTENDEE #6 ADDITIONAL BOOKING DETAILS:

PAYMENT