Mourne Mountain Adventure 2012 (MMA 12) ENTRY APPLICATION FORM

Mourne Mountain Adventure 2017

Taking place on Saturday 22 April 2017

ENTRY FORM

Due to the level of interest all entry forms must be returned by Friday 27 January 2017

Team places will be allocated by sponsoring organisations and 20 additional team places are available on a first come first served basis.

Organisation Name:
Main Contact:
Contact Address:
Telephone:
Mobile:
Email:
Group Leader accompanying team at the event if different from above:
Group Leader’s Contact Details: / Mobile:
Work Tel:
Email:
Entering Team(s) to the Challenge (1 or 2)
Entering Team(s) to the Expedition (1 or 2)
The team and staff hold third party group insurance against accident and damage up to £5M. / Yes / No
Team Category / Please
tick / I am:
Cadet Forces. / The Commanding Officer of the cadet unit to which the team members belong.
Scouts. / The Scout District Adventure Training / Outdoor Pursuits Advisor.
School. / Head Teacher of the school at which team members are pupils.
National Youth Organisations. / Recognised youth leader or equivalent in charge of a local youth organisation recognised by the Local Authority Outdoor Education Adviser to which the team members belong.
Other / A ‘competent’ adult with personal knowledge of the team members. (Where the team being entered does not belong to a formal establishment).
Or Specify:
Acceptance
I approve this application to enter the team(s) listed above in the MMA 17 and understand my responsibilities as head of the organisation, in particular:
I accept the Conditions of Entry MMA 17 and agree to abide by the Rules
The Group Leader is appropriately experienced / qualified to:
assess the risks
manage the activity
manage the specific group
train and supervise the teams training in the Mourne Mountains
Participate in safety briefing and assist volunteer group MUST in safety of their team
during water activity
All participants will be medically fit, be trained and prepared to undertake an 11k hike (Challenge) or 10k hike (Expedition) over rough terrain with appropriate kit to complete the MMA
Payment must accompany this form and be received by Friday 27 January 2017 to secure the team place (£10 per participant).
Parental permission has been given for photographs to be taken of participants and used for publicity in relation to the Mourne Mountain Adventure.
Signature:
Name:
Title:
Date:

The entry fee (£10 per head - £60 per team of 6), must accompany this form. Please make cheques payable to Newry, Mourne and Down District Council

Please return the completed form and appropriate entry fee to:

Mourne Mountain Adventure

Newry, Mourne and Down District Council

Unit 9 Monaghan Court

Monaghan Street

Newry

BT35 6BH

By Friday 27January 2017

Camping at Donard Park and Silent Valley can be arranged free of charge for interested groups but is not part of the MMA and is not covered by our insurance. Camping is undertaken at your own risk.

If you require a pitch for your team(s) please tick the relevant sections below.

Tick required provision
Donard Park – Friday 21 April 2017
Silent Valley – Saturday 22 April 2017