Speakers, and Workshop Facilitators –
Additional Requirements Form

Please use this form to book accommodation and/or a place at the Gala Dinner if required.
Please view the Accommodation and Gala Dinner pages for more details.

1. Your Details


Title (Mr,Mrs,Ms etc)*:
First Name*:	Surname*
Organisation:	This should be the organisation you are representing at the conference
Email Address:
Telephone:
Role*:	Speaker Workshop Facilitator

2. Accommodation (Optional)

If you require accommodation, please select below. Details of the hotels can be found on the accommodation page
		Holiday Inn	International Hotel
	Sunday 25th October	£70+VAT	£60+VAT
	Monday 26th October	Full	£88+VAT
Smoking room required? Yes No Disabled Room required? Yes No Note: We have secured the above discounted accommodation rates based on a block booking of bedrooms. Accommodation therefore cannot be cancelled once a reservation has been made. However, substitutions will be accepted.

3. Other requirements

Gala Dinner:
Do you require a place at the Gala Dinner at £55.00 + VAT? Yes No

Special requirements:
Do you have any special requirements (dietary, disablities, etc)? Yes No

If yes please give details:

4. Payment (if applicable)

Invoice my organisation
Credit Card	We will contact you by phone to make a credit card payment. We will send you a VAT invoice once the payment has been made.

Purchase Order Number:

Invoice Name & Address

Speakers, and Workshop Facilitators – Additional Requirements Form

Speakers, and Workshop Facilitators –
Additional Requirements Form