Registration Form
Organised by the Rotary Club of Taunton Vale

Note: Please make sure you scroll to the very bottom of the form
Team Name *
Main contact *
(full name)
If Corporate, name of business
Address of main contact *
(contact for the whole team)
Telephone number (home) *
(main contact)
Telephone number (work)
(main contact)
Telephone number (mobile) *
(main contact)
Email address of main contact *
Leader *
(full name and must be at least 17 years old)
Entrant #2 *
(full name)
Entrant #2 age if 16 and under
(see special entry conditions for 16's and under)
Entrant #3 *
(full name)
Entrant #3 age if 16 and under
(see special entry conditions for 16's and under)
Entrant #4
(full name)
Entrant #4 age if 16 and under
(see special entry conditions for 16's and under)
Entrant #5
(full name)
Entrant #5 age if 16 and under
(see special entry conditions for 16's and under)
Entrant #6
(full name)
Entrant #6 age if 16 and under
(see special entry conditions for 16's and under)
Entrant #7
(full name)
Entrant #7 age if 16 and under
(see special entry conditions for 16's and under)
Entrant #8
(full name)
Entrant #8 age if 16 and under
(see special entry conditions for 16's and under)
Please choose which course and your preferred starting time
Course *
Time *
(starting times will allocated on a first come first served basis, please book early)
Fee due *
(£20 per person or £5 for under 16's)
Permissions
I give permission for any photos taken of me or my team to be used for the future promotion of Moonraker or Rotary purposes. These images will not be made available to any person or organisation outside of Rotary Club of Taunton Vale
I have read the Entry Terms and Conditions *
Required
Two ways to pay
a) online bank transfer to 'Rotary Club of Taunton Vale Trust Fund', HSBC Taunton, Sortcode 40-44-04, Account number 71202812

b) cheques made payable to 'Rotary Club of Taunton Vale Trust Fund' and posted to 'Jas Shorney, Lyddons Mead, Nailsbourne, Taunton, TA2 8AF'

Entries will not be confirmed until payment is received.
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