THE WELSH 1000 LEADER REGISTRATION FORM 2019 Show/Hide Details --> First Name Last Name Email Address Which walk do you wish to lead Select One 5 6 8 10 11 13 14 15 16 17 18 19 22 23 24 25 27 28 29 31 33 34 38 39 40 41 42 43 44 45 46 48 49 52 55 57 58 61 64 68 69 71 Please indicate, if you would be prepared to lead an alternative route? Select One Yes No 2nd Choice Select One 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 3rd choice Select One 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 Title Select One Mr Mrs Miss Ms Dr Date of Birth Sex Select One Male Female Address Post Code Telephone Number Mobile Number Do you have any medical conditions? Yes No If yes, please provide details below Experience level of leading walks Select One Beginner Intermediate Experienced How often to you lead walks? Select One 0-5 per year 10-15 per year more than 15 per year Are you a member of a Walking / Rambling organisation? Yes No If yes, please give details Contact name in the event of an emergency Contact telephone number of emergency contact Do you have an up-to-date basic First Aid training qualification? You must have this to lead a walk Select One Yes Please enter here any additional information you would like us to know How did you find out about theWelsh1000walk Select One Website flyer Radio local press/adverts Reason for taking part? Please confirm you have read and accept our registration and event conditions? Select One Yes REGISTRATION FEES You must select at least one item! 0 1 0.00 Total
