Name(s):
Address:
Contact Phone Numbers: Home: Mobile:
Email:
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
Sleeping arrangements available: Single Room Double Room Twin Room (Please check all applicable)
Please tell us if there is a particular family or person in Triel who you would like to host (optional): (Although your preferences will be taken into account, no guarantee can be given.)
Additional information (optional):
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By submitting this form you agree to your details being shared with the committee and other members of the Association.