Ben's test page.

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Select Trip

Bummit 2016 

Please don't be tempted to say you're on a different trip... We have a list of names for who is on trip 1 and 2, this just helps us to find you!

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Personal Information

Alternative Contact Details

GP (Doctor's) details

If you are not registered with the University Health Service then you need to change this:

Insurance Questionnaire

Are you permanently a resident in the United Kingdom and registered with a Medical Practitioner in the United Kingdom, whose address is given in the 'GP Details' section above? *

If you answered 'No', please explain your situation below:

Do you have any medical condition that you think we should know about, or which may exclude you from obtaining travel insurance under our travel insurance policy? *

If you answered 'Yes' or 'Don't know', please explain your situation below:

Declarations

I realise that hitch-hiking contains an element of risk and that my safety whilst on the trip is my own responsibility. I agree to take the up most care in ensuring my safety and well being whilst taking part in Bummit, and realise that the liability of the Bummit Committee and the University of Sheffield Union of Students is limited solely to the event.

I declare that if I am eligible for an EHIC Card, I will apply for one in good time and carry it with me on the event, or contact and make appropriate arrangements with the Bummit Committee as required
I am aware that my ticket price will not refunded, and if I withdraw after the 11th February, neither will my sponsorship deposit.

I declare that I am submitting this application for myself and that the information provided relates to me. I also confirm that the information provided on this form is to the best of my knowledge complete and correct, and that I will inform the Bummit Committee about any changes in my personal circumstances which may impact upon insurance policies or my participation in the event in general.

I declare that I have read and accept the Bummit Terms and Conditions.

I declare that I acknowledge that I am fundrasing via the website Virgin Money Giving and not any other alternative fundraising website.

I understand that if I am an international student requiring a visa that Bummit will be unable to provide help if I buy a ticket after February 8th.

 

 



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