Application Form

Name of the group (if any)

Number in the group

Club representatives who will liaise with us.

First Representative
Title
First name Last name
Address
 
 
 
 
Post code
Country
Telephone (inc. STD code)

 

Second Representative
Title
First name Last name
Address
 
 
 
 
Post code
Country
Telephone (inc. STD code)

Choice of year 1st - 2nd - 3rd - 4th - 5th

Reason for your first choice.

We would be happy with any year, if our chosen year is unavailable
We would consider a second panel in the unlikely event that there are insufficient groups

Our group members may be able to help, at a later date, to approach local schools for a sponsored stitch on the last panel and help to oversee it

Please Note. Your answer to the last two questions will in no way affect your application.

If you have trouble sending this form, please print it out and post it to this address.

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