Please fill out the form to the best of your ability. If you have any issues filling out the form please contact us on 07985 111233 or Email info@vivitas.co.uk
FULL NAME:
 EMAIL:
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 MOBILE PHONE:
HOUSE NUMBER/NAME:
STREET NAME:
TOWN:
POSTCODE:
ORGANISATION:
YOUR POSITION IN ORGANISATION:
   
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
 
DIETARY REQUIREMENTS
 

FOR INFORMATION AND ACCESS REQUIREMENTS

PLEASE TYPE YES NEXT TO YOUR REQUIREMENT(S)
Print size 14 font
 Large Print size 18 font
Extra large print size 24 point font
 Braille
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 Loop system
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OTHER USEFUL INFORMARTION
  

 

PLEASE MAKE ALL CHEQUES PAYABLE TO EMREC

PLEASE SEND CHEQUES TO :

EMREC
Conference Organizer
473B Alfreton Road Radford
Nottingham NG7 5NH

Please note confirmation of registration will be sent out on receipt of cheque or BACS payments
DETAILS FOR BACS PAYMENTS LLOYDS TSB BANK ACCOUNT
 
Account Name East Midlands Racial Equality Consortium
Account Number 01716967
Sort Code 30-95-21
Booking Reference Equality Conference
   
CONFERENCE FEE :
 
Statutory Sector organisations £100.00 per delegate
Third Sector organisations £25.00 per delegate
Private Sector  organisations £250.00 per delegate