Young Shot's Name:

_____________________________________

Age:

____           Date of Birth:   _____________

Your Name:

_____________________________________

Relationship to
Young Shot:

_____________________________________

Address:

_____________________________________

_____________________________________

_____________________________________

Postcode:

__________________

Daytime Telephone:

__________________

E-mail:

__________________

I enclose:
A cheque for £ _____________
(Please make cheques payable to Holland & Holland).

OR
Credit card details

Card number:

_____________________________

Expiry date:

____________

Security code:

______

Billing address:

_____________________________
_____________________________
_____________________________

Billing postcode:

____________

Signed:

_____________________________

Date:

____________

If you are purchasing a place on the course as a gift and
require a gift certificate, please place a tick here: ___

Eligibility is at the sole discretion of Holland & Holland.