Brathay Exploration Group | Expedition Form

Expedition Form

Expedition/Course Application Form

Please complete all parts of this form fully, including the accompanying medical questionnaire. Submitting an incomplete application may cause a delay. Places on expeditions are limited and the information you give here will be used by the leader to help select their memebers.

Contact Details/Membership Application. (Details should be
identical to those shown in your passport)

Complete all compulsory fields, denoted by Required Field

, any form errors will be listed below and the field will be prefixed with a Error

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Title:

Brathay member:
Forename:

DOB:
Surname:

Nationality:
Passport Number:

Occupation:
Dietary Information:
Address1:

Address2:
Address3:

Address4:
PostCode:

TelDay:
TelMob:

TelEve:
Email:

Parent or Guardian Details if Applicant is under 18 years of age:

Title:
Forename:

Surname:
Address1:

Address2:
Address3:

Address4:
PostCode:

TelDay:
TelMob:

TelEve:
Email:

If you are a student, please give the name and address of your school, college or university:

Is there a member of staff who would be willing to receive information from Brathay Exploration Group and post it on the notice board? Please give their name if you can, but only after asking their permission:

Thank you for your help.

Expedition/Course Choice (Selected from our brochure or website):

First Choice:

Second Choice:

Your Experience of expeditions, outdoor activities or fieldwork

Last Brathay Exploration Group expedition I went on	Year

Scientific Fieldwork (give location, type and level. Eg. Geology A level on Arran):

Fieldwork	Year

Camping, Fell Walking and Backpacking (give locations and say who with):

Camping, Fell Walking and Backpacking	Year

Other Outdoor Pursuits:

Hobbies and Interests:

In a few words, what would you hope to gain for the expedition/course?:

Referee: you should give here the details of a person who knows you well,
preferably from an expedition or outdoor activities perspective.

Title:
Forename:

Surname:
Address1:

Address2:
Address3:

Address4:
PostCode:

TelDay:
TelMob:

TelEve:
Email:

If you are new to Brathay Exploration Group please tell us how you heard about us - please be as specific as possible:

Clicking submit processses your application and prompts you to print a copy of this page, it must be signed and returned with a passport sized photo, the deposit and memebership fee. Further instructions will be on the printed application.

Submit Cancel