Test Form Page NiB Main Entry Name of your group or organisation(Required)Location of your entry(Required)Please name your village, town or city. This is the name which will appear on your certificate – so choose carefully!Entry Class(Required) D – Urban Community E – City Centre Prefix(Required)MrMrsMissMsDrName (of the person responsible for this entry)(Required)Please ensure that the name you enter is that of a person who can be contacted about this entry First Last Position in your group or organisationFor example, ‘Parish Clerk’ or ‘Chair’ or ‘Organiser’Email(Required) Enter Email Confirm Email Telephone(Required)MobileTotal Payment Options Pay by Card Pay by Cheque or BACS Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Card PaymentWe use PayPal to process our payments. If you do not use PayPal, you can still pay by credit or debit card – simply press the PayPal button and then in the window that opens, select the ‘Pay with Debit or Credit Card’ option.ChequePlease make your cheque payable to ’Northumbria in Bloom’ or make a BACS payment. Full details are presented on the confirmation page.
