WALK ON HEBRIDES
WALK 500 MILES CHALLENGE
REGISTRATION FORM
Name: ____________________________________________
Address: ___________________________________________
___________________________________________
___________________________________________
Contact Tel No: ______________________________________
Date of Birth: _______________________________________
MALE
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FEMALE
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Please list any special requirements or health issues you may have:
Please return this form to: Lorraine Gillies, Health Promotion, NHS Western Isles,
37 South Beach, Stornoway, HS1 2BB.
For an electronic copy of the form please email: [email protected], or visit
www.promotionswi.scot.nhs.uk
For further information contact: Chris Ryan, 01851 702712, [email protected]