Please print off, complete, and return to Trix Awards Secretary, Jordans, Jordan Green, Whitwell, Norwich NR10 4RQ
SCHOOL:(BLOCK CAPITALS PLEASE)
BSCA Region No on School Roll  
Address
 
  Post code Tel:
Rider Name  (BLOCK CAPITALS PLEASE) D.O B Sex M/F Award claimed Fee
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  Cheques to be payable to BSCA  

TOTAL FEE ENCLOSED

 £

I certify that the details given have been recorded and checked by me personally, and that the award attempts were conducted in compliance with the current BSCA Award Scheme Regulations

Signed.........................................   Date  ..................................