Return to Well Road Centre, Moffat

Well Road Centre - Booking Form

Please complete all parts of the form and send completed form with deposit to :-
Ben Larmour, Huntly Lodge, Well Road, Moffat, Dumfriesshire DG10 9JT SCOTLAND

For more information : Telephone 01683 221040 or 01683 220107, Fax 01683 220832,
or e-mail Ben8363@aol.com.

Name of Group : ____________________________________________

Lead Name : ________________________________

Contact E-mail (ESSENTIAL) : ______________________________________

Postal Address :

Street : _____________________________________________________

Town : _________________________________________________

City or County : _________________________________________

Post or Zip Code : __________________

Country : ____________________

Telephone Number (ESSENTIAL) :__________________

Fax Number : ___________________

Date of Arrival :_________________________________________

Date of Departure :_______________________________________

Estimated Group Size :____________________________________

Deposit Enclosed (Pounds Sterling) :________________________

N.B. : Cheques on Scottish or UK banks only, backed by banker's card.
Never send notes or money by post. Contact us to discuss other forms of payment.