Lowland Expedition Leader Registration Traditional course

Course that you are applying for *

Lowland Expedition Leader Lowland Day Walk Leader

Full Name *

First Name Last Name

Personal E-mail *

not school one if possible, we will not pass this on without your permission

Home Address *

House number/name
Street Address
Town	County
Postcode	Country

Phone Number

First 5 digits Last 6 digits

Mobile Phone number

First 5 digits last 6 digits

Date of Birth *

Month Day Year

This is a physical course so please give details of any medical conditions that we should know about

please confirm none if appropriate.

Your work email if appropriate

Name of an emergency contact

First Name Last Name

Their contact number

First 5 digits Last 6 digits

School or Group if appropriate

School or group address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Have you completed any of the following

Mountain leader training Walking Group Leader Training Hill and moorland leader training Lowland leader training

Please give brief details of experience that you already have

Thank you for registering to do the LEL course with us. Please note that this course requires a minimum number to run therefore we may not be able to run if that number is not reached. Provided the course is running we will be in touch soon and send you an invoice.

Please give details below of who to invoice and the best method of contact, we can send invoice by email or by post.

Invoice to:-

First Name Last Name

E-mail

Address

Organisation
Street Address
Town	County
Postcode	Country

Lowland Expedition Leader Application form