Knowledge Support Learning CIC

REGISTRATION FORM *required entries

OUR EVENT OR COURSE

Event or course*
Place and dates*
Rate and fee*

Membership/staff number/invitation code
(*if applying for ‘By Invitation’ or ‘Special Rate’)

YOUR DETAILS

Organisations and partnerships: Please submit one form per delegate for group bookings; we provide an invoice for each fee-paying person in case different cost centres (or purchase order no’s/org codes) apply to different people.

First name*
Last name*
Email address*
Phone number*
Organisation
Position or role
Work address
Organisation type

YOUR PAYMENT

Payment method (where payment applies)
Card (secure online – "paid" invoice sent afterward to the supplied address) Invoice (sent "for payment" – if you’re unable to pay beforehand by card online)

Invoicing method (where invoice applies)
Send by email – to above email address (unless another is specified below) Send in post – to work address above (unless another is specified below)

Invoice name/address (if different)
PO no./org. code (if required)

FOR ACCESS & EQUALITIES MANAGEMENT

Age group
Ethnic group
Employment status

Gender
Male Female

Do you consider yourself to have a health/learning difficulty or disability?
Yes No

Dietary requirements (if any)
Other special requirements (if any)

SUBSCRIBE NOW FOR FURTHER INFORMATION

Sector interests
Children & young people Substance misuse Health & wellbeing Mental health

Service interests
Training programmes Contracting support Events opportunities Project support

Privacy guarantee* My information will be kept safe and will never be sold or rented. I’m happy for KSL to keep in touch. I may unsubscribe any time by unchecking and resending this form.

How I heard about this event or course

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REGISTRATION PHONELINE

We recommend online registration/payment, but if you have difficulties, please provide the same information as requested in the forms on the left or below to our:

Dedicated phoneline
020 3355 5267
Dedicated fax line
020 3355 5268

PAY NOW SECURELY ONLINE
Online payment fees all include VAT