ࡱ > bjbj>> Oc pT pT . ^ ^ # # # # # # # # 8 $ $ d # 0 $ $ ( $ $ $ F* F* F* P0 R0 R0 R0 R0 R0 R0 $ 2 m5 v0 # F* * * @ F* F* v0 # # $ $ D 0 N+ N+ N+ F* R # $ # $ P0 N+ F* P0 N+ N+ : T. , . $ P#. * R . <0 0 0 0 . k6 * d k6 . k6 # . F* F* N+ F* F* F* F* F* v0 v0 N+ F* F* F* 0 F* F* F* F* k6 F* F* F* F* F* F* F* F* F* ^ ~" : Application Form and DeclarationRoom to Breathe Group Although we shall endeavour to lead this event with all due care and safety, we need participants to be responsible for their own physical well-being. Please sign this declaration and return it to Chris Powell at least 3 days before the walk. PLEASE USE BLOCK CAPITALS AND COMPLETE ALL SECTIONS. I understand that I am going to undertake a physical activity in the open-air, and that such activities are potentially hazardous. I understand that I am responsible for my own physical well-being and safety, and will behave in a manner to ensure my own and others safety. I declare that I am not aware of having any physical illness or disability that would prevent me from hill-walking safely. I am sufficiently physically fit to walk for 8 miles in hill country and spend the day on the hills in poor weather conditions. SignedDatePrint nameAddress Email addressHome phone numberMobile phone numberPerson to contact in case of emergency NameMobile phone numberHome phone numberWork phone numberPlease return to Chris Powell, 1 Hilton Place, Harehills, Leeds, LS8 4HE at least 3 days before the walk along with a cheque for 36 for one day, or 108 to book four days, made out to Spark, or contact HYPERLINK "mailto:chris@spark.uk.net" chris@spark.uk.net for details for electronic bank transfer. Please contact Chris if you have any queries about the form, the payment or the walk. PAGE 1 PAGE 1 ) + _ ` o p w y ~ > K Ǿ|sf\ h: B* ^J ph ` hIe h