Booking Form

MountainZ Booking Form

* Indicates required field

Name *

Address *

Postcode *

Email *

Telephone *

Mobile *

Date of Birth *

Occupation *

Sex *

Male Female

Next of Kin *

Relationship *

Contact Number *

Accommodation Details *

Course Description *

Course Requests *

Start Date *

Finish Date *

Location *

Medical Information *

Summary of Experience *

British Mountaineering Council Participation Statement
'The British Mountaineering Council recognises that climbing and mountaineering are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions.'

Declaration *

. I agree to the booking terms & conditions . I have read & understood the BMC Participation Statement

Mailing List *

. Please tick if you would like to be added to our mailing list for occasional emails, special offers & news items.

Name *

Date *

Submit

Payment options

We can accept payment by the following methods

Cheque (addressed to Zac Poulton)
Bank Transfer (Please contact us for our account details)
PayPal (Please click on the link to the right) after you have submited your form.