Application Form - Gordon & Penny Curley - Evangelist Christian Gospel Preacher in Hampshire

2:42 Experience Application Form

Please complete one application form for EACH person attending.

Please fill out the automated contact form below, and then securely pay online using PayPal.

Online Application Form

Attendee Information:

Full Name*
Gender*	MaleFemale
Address*
Postcode*
Phone
Email*
Date of Birth (if under 18)
Doctor's Name*
Doctor's Phone*
Emergency Contact Details (Parent/Guardian if Under 18):
Full Name*
Relationship*
Phone
Email
Emergency Contact #*
Address (If Different to Above)
Additional Information (Answer No or Yes and Give Details):
Special Dietary Needs	e.g. 'vegetarian'
Arriving as a:*	Family Church Group Youth Group Other
Group Leader Name*
All fields marked * are required.
Please read and select:
I am over 18 and I agree that the information on this form is correct. If required, I agree that emergency medical treatment may be given as appropriate. I am a Parent/Guardian and I have read the information contained in the brochure or on the relevant section of this website, and I am willing for my child to attend the event. The person applying is fit to attend the event and is able to participate in all activities (unless otherwise indicated in my reply to your follow-up email). She/He will abide by event rules or I am willing to collect my child from the event and take him/her back home. If required, I agree that emergency medical treatment may be given as appropriate.

After you fill out the online form above, you will be sent an email to request additional information. You can respond to this request by email or by post.

You will also be linked directly to a page where you can click the PayPal secure payment button to make payment.

We will endeavour to resolve any issues ourselves. In the first instance of any dispute please contact us, however our dispute resolution process is also party to the EU Online Dispute Resolution service.

2:42 Experience Application Form

Online Application Form

Attendee Information:

Emergency Contact Details (Parent/Guardian if Under 18):

Additional Information (Answer No or Yes and Give Details):