Please use this form to register for the Afasic Snowdon Climb on Saturday 13 May 2017. Each person will need to complete a separate form. Fill in all your details, choose a payment option then click 'register now'. You can then make your payment with your debit or credit card. Your name* First Last Home address* Address Town/City County Postcode Email address* Daytime phone number*Evening phone number*Mobile phone number*Age (at 13/05/2017)*If under 18 must be accompanied by a 'responsible adult'.Any dietary requirements*If you have no requirements, please type "none".Any allergies to medicine or food*If you have no allergies, please type "none".Any medical conditions we should be aware of*If you have no medical conditions, please type "none". Next of kin details in case of emergency during the event:Emergency contact (name)*Relationship*Emergency contact phone (daytime)*Emergency contact phone (evening)*Emergency contact phone (mobile)*Payment - (please choose an option)*For the family option, we will contact the person completing this form for full details of other family members.Snowdon Climb 2017 - Pay £10 per person and agree to raise a MINIMUM of £100 sponsorshipSnowdon Climb 2017 - Pay £40 per person with no minimum sponsorship amount to raiseSnowdon Climb 2017 - Pay £20 per family and agree to raise a MINIMUM of £100 sponsorshipWhere did you hear about the Afasic Snowdon Climb?* Afasic website Facebook Twitter Newsletter Email Other Please tell us where you heard about this event* Afasic Snowdon Climb - 13 May 2017 Terms & Conditions of Entry Afasic Snowdon Climb 2017 - terms and conditions (194.5 KiB, 178 hits)Acceptance of terms and conditions of entry*Please download and read the terms and conditions above. Yes, I confirm that I have read and understood the terms and conditions of the Afasic Snowdon Climb 2017.