HASSRA Y&H FLAMINGOLAND TICKET OFFER
                 
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               1.  Please record your name. *
                                        
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               2.  Please record your membership number. (this is the National HASSRA number not a local HASSRA Leeds one beginning with LEE) *
                                        
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               3.  Please record your email address. *
                                        
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               4.  Please record a contact number. *
                                        
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               5.  Please record the name of your local HASSRA club. *
                                        
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               6.  Please record the number of tickets required. *
 | Places required | 
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| HASSRA YH Members (£7.50 per ticket maximum of 4 tickets per member) |  | 
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| Non-members (£27 per ticket, no limit to number of tickets) |  | 
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               7.  By completing the information above I acknowledge that I am a HASSRA member and I am applying for the places on the trip on the understanding that no insurance is provided and I am required to arrange my own insurance for myself and any other members of my party. HASSRA cannot be held responsible for any injuries or losses sustained.  If I am successful in the draw I agree to pay for my tickets within 14 days of being notified of my place(s). *