Paid By PayPal

Paid By PayPal

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Paid By PayPal

Before completing this form please make sure that your payment has been confirmed and you have had a reply email from PayPal. This will include your Transaction ID this is normally at the top of the Transaction Details Page. Without this we can not identify your payment.

Please make sure you complete all fields that are marked with an Asterix.

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*Age:

*Title:

*Participants Name:

*Age:

*Date Of Birth:

*Address:

*Post Code:

Occupation:

*Home Telephone:

Work Telephoe:

*Mobile Telephone:

*Dietary Requirements:

*Medical Conditions:

*Past Experience:

*Emergency Contact Details:

*Email Address:

*Course Title:

*PayPal Transaction ID:

*Total Paid: £:

*Do You Require Insurance:

*Have you read the statement at the botom of page:

*Renter your Email Address:

*Electronic Signature:

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*Todays Date: DD/MM/YY:

PLEASE READ BEFORE SUBMITTING THIS FORM

I have read and understood the terms and conditions relating to the booking, in particular those concerning cancellation. I understand that bookings are accepted on the understanding that SRA Ltd safety regulations are observed. I accept that SRA Ltd is not under any liability whatsoever in respect of loss or damage to personal property, not caused by negligent or default of SRA Ltd, its suppliers, its agents and employees whilst attending the course. I have had my attention drawn to the information on the insurance cover, terms and conditions.

Participation in adventurous activities entails some risk of injury. Southern Rock Adventures Limited are trained and appropriately qualified to run activity sessions and will at all times proceed in a manner to limit the risk of injury. However participants accept that accidents and injury may occur.

Please continue to complete the rest of the booking form and once completed please click the Submit button at the bottom of this form.

Thank You.

We accept PayPal Payments for all of our online bookings using any of the Credit/Debit Card listed below. All payments are 100% secure using 128bit Encryption.

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Company Reg No: 06721875 VAT No: GB 938 5325 00

Registered in England & Wales, Registered Office: 31-33 Penel Orlieu, Bridgwater, Somerset, England UK, TA6 3PF

All information contained on this web site is purely information only as can not be used as pure fact.

SRA are the sole holders of the copyrights.

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