Application form to join world record attempt

Wednesday 24th October 07

This, I hope, is your application form to join my support team. You can copy and past to eith email or word. Thank you for applying. I lookforward to meeting you. Mary Laver

Application to join Mary Laver
As part of her
Lands End to John O’Groats Support Team
June 2008


Name……………………………………………………………………….

Address…………………………………………………………………….
……………………………………………………………………………..
……………………………………………………………………………..

Post Code…………………………..

Tel no ……………………………..

Mobile……………………………..

Email Address…………………………..

Age………………..

Type of support, Bike Rider/Carer/Driver/ Cross out which does not apply. Driver/ You must be over 25 with a clean driving licence

Date joining team………………………………….

Date leaving team…………………………………..

Next of Kin…………………………………………..

Relationship with Next of Kin………………………………………

Next of Kin contact tel no…………………………………….

Any medical condition I should no about?
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….


Your expense that you wish to claim for

……………………………………………………………….
………………………………………………………………..
………………………………………………………………..

Any other information that will be of any use in an emergency

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

What special expertise you can bring to the venture?
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

I am asking all team members to raise a minim of £150 for my charity. Are you prepared to do this? Yes/No Cross out which does not apply

Can you help publicise the event in you local area? Yes/No Cross out which does not apply.

Food

Are you a vegetarian Tick Yes/No Cross out which does not apply

Anything you do not like to eat

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..



Can you fund raise toward your costs Yes/No Cross out which does not apply


That is the form filled in and thanks you.

You can now email it to Jack Adams on jack_adams41@msn.com
or post it to
Mr Jack Adams,
19 Imperial Crescent
Norton
Stockton-on-Tees
TS20 2ER
Tel 01642 657752


Best Wishes

Mary Laver