Event Booking Form - Download as DOC by 9wII2w

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									                     Event Booking Form

Event Name:
Date:
Time:
Address:


Thank you for your interest in coming to this event. To book your
place, please complete this booking form and let us know of any
access needs you may have.

To book your place
Please return this form by date to named contact at organisation or
department:

By email: insert email address
By post: Address 1
          Address 2
          Address 3
          postcode

We will contact you again to confirm that you have a place. We will
then send you more detailed information about the event.

More information:
If you need more information about the event, please contact
named contact on the details above or contact:

By telephone:
By fax:




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Contact Details

  Name:

  Organisation (if applicable):

  Contact details (please fill in at least 2 ways to contact you, and mark the
  box    with your preferred method of contact)
     Tel:
     Mob:          (   Text/SMS only)
     Email:
     Address:



Access Needs

We want you to be able to take part fully. Please help us by telling us about
your access needs.

In what format do you need your information?
(Please mark the box       next to the one that applies to you)

   Standard Print (14 pt like this)
   Large Print (18 pt like this)
   Larger Print - Specify font size:                         pt
   Braille
   Easy Read
   Electronic
          Microsoft Word
          PDF
          RTF/plain text
   Audio CD
   Audio Tape
   Other – please tell us what you need



                                                                                 2
Do you need any of these types of communication support?
(Please mark the box         if one applies to you)

   Hearing Induction loop
   BSL Interpreter
   Palantypist (speech to text transcription)
   Other communication support – please tell us what you need


What other access issues do we need to know about?
(Please mark the box         if any apply to you)

   I will need regular breaks
   I will need a particular type of chair, such as:
           High backed chair
           Chair with arms
           Soft chair
     If other, please specify
   I will be bringing an assistance dog
   I will be bringing a Personal Assistant/Support Worker
     If so, please let us know the name of the PA


Do you have any specific dietary requirements?
(Please mark the box         if any apply to you)
   Vegetarian
   Vegan
   Halal
   Other (please specify)



continued…




                                                                3
Will you need a parking space reserved for you close to the
entrance of the venue?

Make of car
Registration number
Are you a Blue Badge holder? Yes      No


Do you have any other needs not yet specified?
(Please let us know of anything else that we can assist you with so you can
participate fully in the event)




Thank you for completing this form.


Now please return it to us – see details on the first page.




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