Please print this form to fax or post for your booking.
Please use one form per delegate (a photocopy is acceptable)
Name:
_______________________________________________________
Position:
_______________________________________________________
Organisation:
_______________________________________________________
Address:
_______________________________________________________
_______________________________________________________
_______________________________________________________
Tel:
_______________________________________________________
Special Requirements:
eg. Diet, wheelchair access, hearing or sight disability:
_______________________________________________________
Workshop Preference: (delegates will be able to attend two workshops):
First Choice
________________________________________
Second Choice
________________________________________
Third Choice
________________________________________
Fourth Choice
________________________________________
Every effort will be made to accommodate your preferences, but places will be allocated on a first come first served basis.
Display Boards:
Delegates will have the opportunity to display relevant material relating to their organisations on boards in the conference area. If you would like to use this facility please tick here: _____
Cost:
£45 (incl VAT) for the first delegate from an organisation
£25 (incl VAT) for subsequent delegates from the same organisation and for all delegates from Voluntary Organisations.
Name, Address and Reference (if applicable) for Invoice:
__________________________________________________
__________________________________________________
__________________________________________________
Please return / fax this form by Friday 22nd December to:
Diversity Event,
Lincolnshire TEC,
Beech House,
Witham Park,
Waterside South,
Lincoln, LN5 7JH
Fax Number: (01522) 510534
Contact the Conference Organisers – Lincolnshire Equal Opportunities Reference Group
