western isles challenge
solo entry form

Please enter the details requested - you can do this offline and then reconnect to your service provider to submit the form. 

Please note the following:

1 In the "Experience" section, we will be looking for evidence of competition in adventure races, mountain marathons and/or other events requiring navigation and outdoors as well as running skills
2 The BCU 4-Star Certificate was formerly the Sea Proficiency Certificate, which will also be acceptable, as will non-UK or Forces equivalents.  If the Certificate has already been obtained, please send a copy to Gordon Brown at Blair View, 1 Hillside Cottages, Dalry, Scotland, KA24 4DP
Your Name  

Age at 30th April 2000     Male     Female 
Have you competed in previous Challenges? Yes   No
If Yes, please give year(s)

If UK-based:Area of the country where you live

Country (if outside the UK)

Your Address (Street Address)
(Town)
(County/State)
Post/Zipcode
E-mail Address
Daytime Telephone (Please add country code if ex-UK)
Home Telephone
Fax

Do youhave a BCU 4 Star Certificate?

      Yes   No 

Experience

If you do not have a BCU Certificate, please include a description of your open-water sea kayaking experience

Estimated number in your backup team
I expect to use the event to raise money for Charity Yes No
If yes, which Charity?
 
My entry fee of £150 (inc VAT) will be sent by cheque
Please charge my fee to this credit card
Card Number 

Expiry

(mm/yy)

Name on the Card
 
Declaration (By submitting this form you are agreeing to this Declaration)
I have read, understood and accept the outline rules for the Western Isles Challenge 2000