NYB 2016 Sign-Up Form

Your Name

Nickname

Your Email

Mobile number

Next of Kin Name

Next of Kin Phone Number

Next of Kin Relationship to You

Medical information including any current medication

Dietary requirements and allergies

Date attending from

Date attending to

Estimated arrival time

Have you paid Dan (PayPal danieljnixon@aol.co.uk) or contacted dodgems for bank details (dodgems@scoutlink.net)?
Yes