FULL NAME:


EMAIL:

TELEPHONE:

MOBILE PHONE:

HOUSE NUMBER/NAME:

STREET NAME:

TOWN:

POSTCODE:

ORGANISATION:

YOUR POSITION IN ORGANISATION:

DISABILITY & OTHER PERSONAL NEEDS:

ARE YOU A WHEELCHAIR USER?

WILL YOU NEED SIGN LANGUAGE SUPPORT?

DIETARY REQUIREMENTS

PLEASE TYPE YES AGAINST ONE WORKSHOP YOU WISH TO ATTEND :

Workshop 1 Disabilities

Workshop 2 Gender

Workshop 3 Race

Workshop 4 Faith

Workshop 5 Sexual Orientation

Workshop 6 Age

OTHER USEFUL INFORMARTION