Lowland Expedition Leader Registration Traditional course

Course that you are applying for

Lowland Expedition Leader Lowland Walking 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 *

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

Phone Number *

- Area Code Phone Number

Mobile Phone number

- Area Code Phone Number

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 emergency contact

First Name Last Name

Their contact number

- Area Code Phone Number

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 details of experience that you already have

Thank you for registering to do the LEL course with us we will be intouch regarding payment shortly. 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.

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

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

Lowland Expedition Leader Application form