CLIMBING WALL SUPERVISOR AWARD – REGISTRATION FORM
Name:…………………………………………………………………………………………...…

Address:……………………………………………………………………………......………

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Tel: ……………..……….. (H) …………………………… (W)…………….…………(M)

Email address:…………………………………………………………………………………….

When did you begin climbing?...................................................

What grade are you comfortable leading routes at?....................

What climbing walls have you led routes on? ………………………………

What climbing walls have you bouldered on? ……………………………………………………………………………………………………………

List the climbing walls have you assisted supervising groups on

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Office use only: Registration fee received: Yes / No

Logbook and syllabus issued: Yes / No

Signed:……………………………………………… Date: …………………………………….
Trevor Fisher, Secretary, MLTNI.

Please complete the table below. You must fulfil all registration requirements.

Examples are given in the top rows. 

   

Date	Venue	Activity	Number and grades of routes led (if any)
1. 11/06/05	Ozone	Leading and top roping	3, grades 4+ to 5
2. 15/06/05	Hotrock	Assisting supervision of group from school	None
3. 21/02/05	UCD,Dublin	Bouldering – competed in competition.	28th overall in Male ‘B’

Signed:……………………………………………………………………………………….…….

Name: (Block Capitals):…………………………………………………………………

Date:………………………………………………………………………………………………..