Club booking form

Name *

First Name

Last Name

Forthcoming events:

Please tick each of the events you wish to attend:

Tue 16 Apr - Bingo £6

Tue 23 Apr - Tickled Pink (Best of Broadway) £6 PREPAY

Tue 30 Apr - Zest Dance £6

Tue 7 May - Film Night £6

Tue 14 May - Disco with DJ Jo Jo's crew

Tue 21 May - Bowling at City Bowl £18 MUST BE PREPAID

Tue 4 June - Bingo £6

Tue 11 June - Skittleman PREPAY

Tue 18 June - Zest dance £6

Tue 25 June - Disco with DJ Jo Jo's crew £6

Tue 2 July - Bowling at City Bowl £18 MUST BE PREPAID

Will you be attending with or without a carer? *

Please select one from the list below:

Without a carer

With a parent/carer

With an essential carer

Please tick here if you are a wheelchair user:

How will you be paying? *

Please select one from the list below:

Via PayPal Please select friends and family (see link below)

Direct Bank Transfer (Please contact us for bank details.)

Cheque Made payable to: Grapevine Essex and posted to: Grapevine Essex, c/o 130 Arbour Lane, Chelmsford, CM1 7RW

I would like Penderel's Trust/ECC to be invoiced directly

FOOD ORDERS

Bowling Food Order - 27 Dec

Chicken Nuggets and chips

Beef Burger and chips

Cheese Burger and chips

Quorn Nuggets and chips