Event / Birmingham Christmas Market
Venue
Date of event / 10 December 2016 2 DAYS/1 NIGHT TRIP
Closing date for entries / 30 June 2016

Please complete all sections. CSSC membership numbers must be included.

  1. Member’s Details

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.

M M

Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Other group members

Name / CSSC Number / Relationship to member / Adult/Child(specify age if relevant)

2. PRICE

Members £53.00

Non-Members £99.00

Why pay the non-member price whenCSSC activities are open to your friends or family members? Under our Linked Membership scheme, up to three of your friends or family members can join CSSC and take advantage of our events and offers at the member price. Membership is also available to staff working in the Public Sector such as NHS, local government, teachers, the police, fire fighters and HM Armed forces personnel.

Anyone who is not a member of the CSSC and wants to join can obtain a membership form from Jennifer Yarrow on 01494 888434. If you are unable to quote your CSSC number e.g. lost card, a form for a replacement card can be found online or please contact our customer services team on 01494 888444.

  1. Payment

All entries are on a first come, first served basis.

Payment will be requested by email when your place(s) are confirmed. Payment will be requiredON THE TIME OF BOOKING to guarantee your place(s). If payment is not made by this date your place(s) will be re-offered. If CSSC cancels the event then refunds will be made.

Payment method will be by bank transfer. Our HSBC bank details are:

Sort Code 40:35:18 Account Number 94635779. Please use the reference Birmingham Market/surname. Please email to advise when payment has been made.

Should you be unable to make payment in the above format then please inform the event organiser on

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  1. Important Information

Medical: Please let us know if any member of your group has any physical or medical conditions

Yes/No (Delete as applicable)

If yes, please give details
Any Dietary Requirements

IMPORTANT: These events are active and members should be aware of the physical activities involved. CSSC reserves the right to cancel the event if under subscribed.

All CSSC members taking part in the event are covered by CSSC Sports and Leisure Public Liability Insurance. Please note that this policy is NOT a Personal Accident Policy. Members are encouraged to take out their own insurance policy.

The organiser reserves the right to cancel any event if there are insufficient entries. The organiser’s decision on all matters is final.

Any enquiries directly linked to the event please contactDeana Bell.

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  1. Further Information

To follow.

Signed: Print Name Date:

Please send this form via email to: