Booking
Form
Name .............................. Surname ............................ Title ..................
Date of Birth ....................................
Address ..........................................................................................................
Town / City ..................................................
County / State .................................................    post / ZIP code ..............................
Telephone Day .................................... Evening ...........................................
Fax .................................... E-mail   ..........................................................
Course or Cruise Required ...............................................................................................
Date from

.....................................   Date to ........................................

Previous Experience if any   ..............................................................................................

Other members of party
Title First Name Surname Experience (if any) Date of Birth
.................. .............................   ............................. ........................................ ..................
.................. ............................. ............................. ........................................ ..................
.................. ............................. ............................. ........................................ ..................
.................. ............................. ............................. ........................................ ..................

Special Dietary requirements.................................................................................................................
PAYMENT   DETAILS (For FAX or POST only)

A £100 deposit per person is required to secure your booking.
Cheques made payable to Pembrokeshire Cruising
Please debit my Access/Visa account no.
                               
The sum of £..................... Card Expiry date ...../...... issue no. (debitcard) ............ security code............  Signature.......................................
Address of cardholder........................................................................................................................
Do you require individual cancellation/travel insurance
UK & Eire 3 day £POA Yes    No
  8 day £POA           Yes    No

Please give details of any medical treatment being received...................................................

........................................................................................................................................
I declare to the best of my knowledge, I/we* am/are* not suffering from Angina, Asthma, Diabetes, Epilepsy, Giddy spells or Heart condition and I/we* am/are* fit to participate in the course/cruise*. (*delete as necessary)
Where did you hear about us? Word of mouth 
 
Magazine
(Please State)
 
Boat Show
 
Other
(Please State)
 

  Signature......................................................................           Date....................................................

Subject to our Terms and Conditions
FAX...... 01 646 602501 - Pembrokeshire Cruising

or
POST.... Pembrokeshire Cruising, Neyland Marina, Brunel Quay, Neyland, Pembrokeshire  SA73 1PY