Knowledge Support Learning CIC

OUR EVENT OR COURSE

*required

Event or training course*; and where applicable, fees excluding VAT

Membership/staff number (only if at a special rate or complimentary)

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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 PO no’s/org codes) apply to different people.

Event code
First name
Family/surname
Organisation
Position or role
Postal address
Email address
Telephone no.

Dietary requirements (if any*)

Other special requirements (if any*)

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YOUR PAYMENT

Prefered payment method
(where payment applies*)

Invoice ("for payment")

Card (secure online; "paid" invoice)

Invoicing details, where you need to supply them

Invoice by: Email

Post

PO number/org. code
Invoice name/address

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FOR OUR EQUALITIES MONITORING

Gender

Male

Female

Age group

Ethnic group

Do you have a disability (as defined in the DDA)?

No

Yes

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YOUR PERMISSIONS

We may contact you about our (other) children and young people’s services events and training

We may contact you about our (other) adult health & social care services events and training

We may share your contact details with our (other) events and training partners, though only with them

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HOW DID YOU HEAR ABOUT OUR EVENT/COURSE?*

REGISTRATION PHONELINE

We recommend online registration, but otherwise please provide the same information as requested in the form on the left, to our:

Dedicated phoneline
020 3355 5267
or to our:
Dedicated fax line
020 3355 5268

You may also use these numbers if you have any registration or payment difficulties.

PAY NOW SECURELY ONLINE

We will then send a "paid" invoice to the address you supplied when you completed registration.