Andy J Lewis MBE

Please complete the form to register for our exclusive 2021 training camp. You will need to pay a £150 deposit via PayPal or Bank Transfer in order to secure your place. Once you have registered, you will receive details on how to pay the balance.

First Name^*

Please enter your first name

Surname^*

Please enter your surname

Gender^*

Male
Female

Email^*

Telephone Number^*

Please use the following format xxxxx xxxxxx

Address

Address Line 1

Address Line 2

Town / City

County

Country

Post Code

Please enter your home address

Age on first day of preferred camp^*

Please enter your age on the first day of your preferred camp

Training Experience^*

Please give detailed information regarding your training experience (500 char max)

Racing Experience^*

Please give detailed information regarding your race experience (500 char max)

Medical/Dietry Requirements

Please give detailed information regarding any dietry requirements (500 char max)

Flight details

You may provide these details later.

You can pay via PayPal now or offline via bank transfer. It's a bit cheaper offline due to PayPal surcharges.

Payment

Deposit (£ 150)
Full Amount (£ 725)

GDPR Consent^*

I agree with the statement below

By ticking the box above, you are digitally signing this form and confirming that all details given are correct to the best of your knowledge at the time of signing. You also consent to Bespoke Mentoring Ltd securely storing your data. The submitted data will only be used for the purpose of registration to our Training Camps and future events. Bespoke Mentoring Ltd will not distribute or sell your information to third parties.

GDPR Consent Statement

Select a payment method^*

Pay Offline

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