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					                   Stoke Rochford Hall, Grantham, Lincolnshire

                 Friday 4th November – Sunday 6th November 2011

Nominated by:
                             (NUT Local Association/Division or other Organisation)
Signature of Authorisation



Title           Name:                                Surname:
Address:




                                              Postcode:
Telephone:                                    Membership No:
Email:



Details of any other special requirements




Details of any special dietary requirements




Are you a wheelchair user?                                      Yes       No
Do you require assistance?                                      Yes       No
Do you require an induction loop?                               Yes       No
Do you require a sign language Interpreter                      Yes       No
Black Member Constituency Seat – If you are not already on the register for voting in the
next elections in 2012, please register at https://www.teachers.org.uk/joinus/update. You
will need to click on Equality Monitoring at the bottom of the page and fill the details out
there.

CONFERENCE FEE PAYMENT

   PLEASE ENCLOSE A CHEQUE TO THE VALUE OF:
   • £255 (NUT Members with Friday night dinner - £20)
   • £235 (NUT Members without Friday night dinner)
   • £115 (NUT Members - Day Delegate)
   • £320 (Non - Members)
   • £160 (Non NUT Members - Day Delegate)
   Please made Payable to the NATIONAL UNION OF TEACHERS



   PLEASE NOTE:
       receipts will not be issued unless requested;
       reservations will not be made without full payment;
       we regret that fees cannot be reimbursed if individuals cancel their places,
          although we will be happy to admit substitutes;
       the Union does not reimburse travelling expenses centrally; and
       you should contact your local association if you wish to be nominated by
          them or if you wish to seek financial support for your attendance; and
       the use of recreational facilities at Stoke Rochford is FREE.



   Please return to: Black Teachers’ Conference
   Hamilton House, Mabledon Place, London WC1H 9BD
   Fax: 020 7387 8458
   For enquires please email: blackteachers@nut.org.uk

   Please complete and return this form as soon as possible but not later than
   Friday 24th September 2010

				
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