Conference Access Registration Form

Name *

Membership number or post code *

Email or mobile number *

Conference attending and date *

Venue *

I confirm my attendance

I am not available, please contact the substitute delegate

Disability / Additional needs

Braille

Coloured paper

Please specify the colour

Large print

Please specify font size

BSL Interpreter

Induction loop

Wheelchair/scooter access

Limited mobility aisle seat required

Specify left or right aisle

Other need, please specify

I am assisted by my registered carer/facilitator

Please state their name

Guide/medical alert assistance dog

Dietary allergies - please specific

Accommodation needs

I require a Hotel within 5 – 10 minutes walking distance of the conference venue due to restricted mobility

Wheelchair/scooter accessible room

Separate room for registered carer/facilitator

Walk in shower due to mobility requirement

Other please specify

Childcare

My child(ren) will be accompanying me to Conference and will require crèche facility

Consent for storing submitted data *

Yes, I give permission to store and process my data
No, I don't consent to storing and processing my data

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