Name

Representing/Town Crier for

Costumed Escorts Name (if applicable)

Contact Address.

Telephone: (Overseas Criers please include International Code)

Please give details of any dietary requirements

Please give details of any mobility, visual or audio impairments or any other arrangements that are needed to ensure you full participation in this event

A £20 per Crier ENTRY FEE which is non-refundable must accompany your application before they can be processed cheques can be postdated 01/03/2012,

Please make cheques payable to Anthony Church and enclose a photograph and brief introduction of yourself for publicity purposes by the 01/03/2012