MORE Drive 29 November 2015 Application .pdf

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Original filename: MORE Drive 29 November 2015 Application.pdf
Title: Amey Drive for Safety – Application Form & Questionnaire
Author: Amey

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MORE Drive
On Sunday 29 November 2015 we are staging ‘MORE Drive’ – an event aimed at
reducing road accidents among 17 to 30-year olds. The event is being hosted at Millbrook
Proving Ground and will give young drivers the opportunity to improve their driving skills
through practical exercises and workshops to help keep them safe on our roads. The
sessions run from 0900 – 1245 or 1300 – 1645.
To take part in the course, you will need to be aged 17-30 years old, hold a full driving
licence. If you live within either Central Bedfordshire or Luton Borough Council Local
Authority areas the course is free otherwise a subsidised fee of £60 payable at the time of
booking by cheque or credit/debit card (for credit/debit card payment please call 01582
546263) .
Places are allocated on a first come first serve basis. If you are offered a place and then
find that you cannot attend you must let Luton road safety team know at the earliest
possible time and at the latest by 5pm on Wednesday 26 November 2015. We reserve
the right to recover the costs for any cancelled place that we cannot subsequently fill and
for any late cancellation. The charge will be £150 (£90 for participants paid for their
place).
If you would like to apply, and meet these criteria please complete ALL sections of this
form and return to: The Road Safety Team, 4th floor, The Town hall, Luton, LU1 2BQ.
Alternatively, you can scan and email them to roadsafety@luton.gov.uk

MORE Drive

Name: ______________________________________________________________

Date of Birth: (DD/MM/YYYY) ____________________________________________

Gender: (circle)

Male

Female

Address (incl. Postcode): _______________________________________________
___________________________________________________________________
___________________________________________________________________________
___________________________________________________________________
Telephone No: _______________________________________________________

Confirmation Email Address: ____________________________________________
(You will be asked to respond to the confirmation email, if this is not done you will not be
booked on the course)
Driving licence number: ________________________________________________
Manual/automatic _____________________________________________________

Where did you hear about the course? ____________________________________

Emergency Contact on the day: Name: ___________________________________

Relationship to you: __________________________________________________

Telephone No: ______________________________________________________
I can confirm that all information completed is correct and that if I do not attend the course
I will be liable to pay the above fee
Signature ____________________________________________________________
Data Protection Act 1998
Personal contact details obtained via forms will be stored securely and will only be used for
communication purposes. We will not distribute, sell, trade or rent your personal information to third
parties. Statistical data obtained from questionnaires will be collated and aggregate data will be used in
any reported outputs. Such statistical data will not include personally identifying information.


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