Friends of Triel

Name(s):

Address:

Contact Phone Numbers: Home: Mobile:

Email:

(A copy of this form will be sent to this email address)

Emergency Contact Details:

Have you paid your annual subscription to Leatherhead Twinning Association: Yes No
(If No, please complete the Annual Membership Application otherwise this form may not be processed)

Describe level of spoken French:

Do you smoke? Yes No

Your approximate age(s):
Person 1: Under 21 21-40 41-60 61-80 Over 80
Person 2 (if applicable): Under 21 21-40 41-60 61-80 Over 80

Dietary requirements:

Any mobility issues:

Preferred sleeping arrangements: Single Room Double Room Twin Room

Please tell us if there is a particular family or person in Triel with whom you would like to stay (optional):

(Although your preferences will be taken into account, no guarantee can be given.)

Additional information (optional):

Payment may be made by cheque (payable to Leatherhead and District Twinning Association) or by bank transfer to our twinning account, sort code 30-92-70, account number 01983584.

Cheques should be sent to David Crutchley, Treasurer, 17 Fife Way, Bookham, Surrey. KT23 3PH

All personal information given by members to the Leatherhead and District Twinning Association (LTA) will be used solely for the purposes of the LTA and will not be divulged to any third party. None of the data entered on this form will be stored on this website.

By submitting this form you agree to your details being shared with the committee and other members of the Association.

I have my own travel insurance and a valid European Health Insurance Card (EHIC).