The Next Chapter Booking form for members - Surrey Coalition of Disabled People

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The Coalition: The Next Chapter – booking form for members

Attendance

Name(Required)

First Last

Phone number(Required)

Email address(Required)

Address(Required)

Street Address Address Line 2 City County Postal Code

Attendance(Required)

I will attend in person

Please note that if you reply after the closing date of Thursday 31st October then we will not be able to book transport for you. Also please fill in the following information:

Transport

We encourage you to travel to Dorking Halls independently if possible.

Do you need transport arranged for you or help to plan your journey?(Required)

Yes

No

Please note, we will be unable to book any transport after the Friday 31st October, therefore please tell us early if you require transport.

Wheelchair information

Will you be using a wheelchair on the day?

Manual

Electric

Neither

If you will be using a wheelchair and need transport, can you transfer?

Yes

No

Other requirements

A Loop System, BSL interpreter, Makaton interpreter, speech to text reporting and Personal Assistance will be available on the day. Please let us know if you have any other needs in the space below.

I will be bringing a PA(Required)

Yes

No

My other accessibility and access needs are:

Lunch

We will provide a sandwich lunch. Please note that changes to the sandwiches are not possible. Please make a selection of a sandwich you will receive on the day(Required)

Simply Cheddar Cheese in White

Simply Ham in White

Tuna, Sweetcorn & Lettuce in Malted

Double Egg & Cress in Malted

Classic Chicken Salad in Malted

Ham & Cheddar in White

Bacon, Lettuce & Tomato in White

Vegan BLT in Malted (Vegan)

Egg & Cress in Gluten-Free Slice (Gluten Free

Are you attending with a PA? If so, please let us know and also indicate what sandwich you would like to select for the PA

Simply Cheddar Cheese in White

Simply Ham in White

Tuna, Sweetcorn & Lettuce in Malted

Double Egg & Cress in Malted

Classic Chicken Salad in Malted

Ham & Cheddar in White

Bacon, Lettuce & Tomato in White

Vegan BLT in Malted (Vegan)

Egg & Cress in Gluten-Free Slice (Gluten Free

Consent(Required)

Please tick here to confirm you consent to us using the information on this form to register you for the The Next Chapter conference and that you are happy for us to contact you about this event.

Photo consent

Please tick here if you are happy for us to take and store photos of you for use in our promotional materials. This may include email, printed publications; electronic materials (e.g. social media posts and website); and display materials.

Simple acts of kindness that can transform somebody's day to day life

- Tech to Community Connect member

I've not been out for ages; it was really lovely to get out.

- Get More Active Get Together attendee

Contact Information

Address

Surrey Coalition of Disabled People
Astolat, Coniers Way
Burpham, GU4 7HL

Email

info@surreycoalition.org.uk

Call or text

Tel: 01483 456558

Text: 07908671402

Important Links

Useful information

Story & Photo consent form

Volunteer for the Coalition

Fundraising Regulator badge with validation link

Registered Charity Number: 1206289
Registered address: Astolat, Coniers Way, Burpham, Guildford GU4 7HL
Company Limited by Guarantee, number 3298760

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