Stonewall Scotland Workplace Conference Booking Form

* Required field

Title:	*
First name:	*
Second name:	*
Job title:	*
Organisation:	*
Sector:	*
Industry:	*
Number of employees:	*
Address:	*
Telephone	*
Email:	*
Please select the applicable rate:	*

Number of delegates at applicable rate:	*

I have read the cancellation policy below and agree with the terms and conditions:

Access and dietary requirements:

You will attend two breakout sessions at the conference.Please select your first, second and third preferences from the following drop down boxes
First
Second
Third
We will of course endeavour to accommodate everyone�s first choices of breakout, but places will be limited and will have to be allocated on a first come, first served basis

Please list the full name, job title and any access or dietary requirements of additional delegates, where known:

Upon receipt of your booking, we will invoice you at the above address. If, however, the invoice address is different from above, please supply the correct address here:

If you will be providing us with a purchase order for the invoice, please tick this box:

If you know the purchase order number, please provide it here:

Where did you hear about the conference?

In accordance with the 1998 Data Protection Act, we will hold your details to provide you with updates. If you wish to receive these please tick this box.

Cancellation Policy: Cancellations made by 15 October 2011 will be charged at 50% of the invoice total. Cancellations made after this date will be charged at the full invoice total. Cancellations must be made in writing to Alice Ross, Stonewall Scotland, 9 Howe Street, Edinburgh, EH3 6TE or via alice.ross@stonewallscotland.org.uk.

Stonewall Scotland Workplace Conference Booking Form

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