Spelthorne Together Assembly - 26 September 2011

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Date completed

To apply for a place at the 2011 Assembly, please complete all the details requested below. Make sure you get your unique booking reference number starting AF***** after pressing submit, it not call Joanne Jones on 01784 446421.

PLEASE NOTE: Numbers are strictly limited so not everyone who applies will be allocated a place.

Either way you will receive notification. If this does not arrive, contact Joane Jones on 01784 446421.

Anyone arriving without a confirmed booking will only be admitted if there are cancellations on the day.

Delegate's details

Name ^*

Position

Organisation

Telephone number ^*

Are you a Spelthorne resident?

YesNo

e-mail address ^*

(providing an e-mail address will help us reduce our costs)

Which one of the WORKSHOPS would you like to attend?

We would like to produce a list of delegates to help people network both on and after the day. Please indicate below what information you wish to be included.

My name/position/organisation and telephone number/email address
My name/position/organisation only
I do not wish to be included in the delegate list

Marketplace

Do you wish to bring a stand on the day?

Space for a free-standing display stand? Dimensions please
Rectangular table
Small table
Electric socket nearby
Other - please specify

Parking is free. The venue is wheelchair accessible. If you have any special requirements (e.g dietary), please describe:

After you submit this form you will receive a screen displaying your unique booking reference number starting with AF. If this number does not appear your booking has not been successful and you will need to call Joanne Jones on 01784 446421 or e-mail partnerships@spelthorne.gov.uk

Have you read and understood the above statement ^*

Yes