Erewash Borough Council
Volunteer and Club Development Programme
Friesland Sports Centre, Nursery Avenue, Sandiacre, Derbyshire NG105AE
Tel no. 07584 856292 0115 907 2244 ex. 4319
Title
Address
First Name(s)
Surname
Postcode
Date of Birth
Gender M/F
Home Telephone
Work Telephone
Mobile
Email
Which Sports Club and/or Voluntary Organisation are you involved with, and in what capacity?:
Please detail any medical condition or disability or any special requirements:
Please book me on the following Course
Course
Date(s) of Course
Cost (inc.VAT)
Total Fee Enclosed
Please make cheques payable to ‘Erewash Borough Council’ and payment to the address above.
Please mark for the attention of ‘Sport Development’
I declare that as a condition of attending the workshop/course I accept that the organisers and their agents cannot be held
responsible for any injury or loss, however caused, unless caused by the negligence of Erewash Borough Council. I agree to the
terms and conditions of the event as stated on the CSN website www.erewashcsn.org.uk (a paper copy can be posted upon
request).
Signed:
Date:
Places are limited on each course so please apply early. Places are only confirmed on receipt of payment.
Your details will be kept in accordance with the Date Protection Act 1998. For more details please see the Data Protection
section under the Courses heading on: www.erewashcsn.org.uk
Please tick this box if you are happy to have your details made available to third parties 