Yorkshire in Bloom Entry Form 2012 (Category 6)

PUBLIC, PRIVATE & CHARITABLE ESTABLISHMENTS (Residential Care Homes, Hospitals, Public Buildings, Church Yards and Hospices etc.)

Name of Public, Private Or Charitable Establishment *

Address of Public, Private Or Charitable Establishment (including Postcode) *

Person Submitting Entry

Full Name *

Address Line 1 *

Address Line 2

Town/City *

County *

Postcode *

Telephone (Preferred) *

Telephone (Other)

Email Address

Secondary Contact

Full Name

Address Line 1

Address Line 2

Town/City

County

Postcode

Telephone (Preferred)

Telephone (Other)

Email Address

For All Entrants:

Payment Method *

If you are not paying online, then please note that all cheques are to be made payable to 'Yorkshire in Bloom'. Send your Cheque or Purchase Order to:

The Honorary Administrator
Yorkshire in Bloom
1 Riding Head Lane
Luddenden
Halifax
HX2 6PT

CLOSING DATE FOR ENTRIES IS 31ST JANUARY 2012