Booking Form 2005

The Boathouse, Adrigole, Beara, Co Cork, Ireland Tel 027 60132 Fax 027 60247 Email info@westcorksailing.com www.westcorksailing.com

OFFICE USE ONLY BD    BK    C    1 rcvd €________ ___ date_____    2 rcvd €________ ___ date_____ 3 rcvd €________ ___ date_____

To reserve a course please print this form & post or fax your completed form with a booking deposit of €75 per
person / per course.  One form is required per person per course. We cannot accept credit card numbers on email.

First Name _____________________  Surname_________________________  Male ___Female___
Address _________________________________________________________________________
Email _____________________ Age_____     Date of Birth ___/___/___ Can you swim? Yes __ No __
Tel Home ____________________ Tel Work __________________ Mobile____________________
Where did you hear of us? ________________ Why did you choose us? ________________________
Any food allergies or preferences?______________________________________________________
Health Problems ________________________Are you on any Medication ?_____________________
What Relevant Experience do you have?_________________________________________________
What Relevant Qualifications do you have?_______________________________________________
Course Details
Course Name___________________________________
Course Code _________  No Days ____    Course Only ___ or Go Inclusive ___ (please mark x)
Course Dates From _______ To _______    Accommodation Dates      Arrive ______ Depart ______
Go Inclusive customers arrive from 5pm evening prior to course start date & check out 9am on last day of course.

Payment Details
We cannot accept payment over the internet, but you can print this and post of fax it with payment.
Please find enclosed a cheque cash draft for € ________
Please charge € __________ to Credit Card no. _________________________  Expiry Date ___ / ___
Cardholder Name _______________________________
Type of Card Visa / Access / Mastercard / Eurocard
I have read the booking conditions and agree to them.
Signed by course attendee _____________________
or Signed by Parent if attendee under 18  ____________________