Send completed form via fax to +44 (0) 1273 325081

Title:
First Name:
Surname:
Date Of Birth:	Day Month Year


Flat No:
House Name:
House Number:
Street:
District:
City:
County:
Post Code/Zip:

Function Details (e.g. Wedding):

Nearest Hotel:

Nearest Airport:

Appearance Fee: £1,500 / $2,250 (1/2 of which will be donated to Charity)

Confirmation

I hereby confirm the above booking and upon receiving your acceptance, I will pay £300 / $450 non-returnable deposit by Bank Transfer. I will pay the balance of £1200 / $1800 at least 28 days before the Function Date. I will book and pay for a hotel room near the function address for the night preceding the function. I accept that no refund will be made in the event of my cancellation.

............................................. Signature

Bank Details

Name:

Address

Account Number

Sort Code: - -

Name of Account Holder