Autumn Gathering - Unstone Grange

Fri 29th to Sun 31st October 2021 (Bookings close 27 Oct 2021)
Please fill in this form as fully as possible, ensuring you answer all questions marked *. PLEASE PRINT CLEARLY.
Send the form with your payment to Jon Homer, c/o 15 Rankine House, Bath Terrace, London SE1 6PL.
Your name and contact details
First Name* Surname*
Postcode* Country (if not UK)
Email Address
Telephone number Mobile
I would like the following to be given out to other participants via a contact list after the event has finished:
Name   Address   Email   Telephone   Mobile   I don't want my name or details to go on the list
Some useful information for us
I have been to an ECC event before* YES   NO
If yes, where and when was the last one?
I heard about ECC from
A friend   Facebook   Google+   ECC Website   Internet search   Another website   Other
Travel to the event
I plan to travel to the event by Car   Bus/Coach   Train   Other
I would like a lift if possible: YES   NO I can offer a lift: YES   NO
If so, for how many people?
Event information
I have the following particular needs (rather than preferences):
Emergency Contact Please nominate someone we can contact in case of emergency*
Their name* Their relationship to you
Their contact phone number* Will they also be on the event? YES   NO
Payment Concessionary rate £35.00, Normal rate £65.00
The total amount I will pay for the event is* £ (Please pay the full amount now)
Please make cheques payable to Edward Carpenter Community Ltd (full words please)
Booking conditions Please tick to indicate you accept all the terms, and sign and date the form*
While the organisers of events take all reasonable care to provide a safe environment for participants, the circumstances of the event and the nature of some activities are such that people will often try out new activities or take risks that the organisers cannot foresee. As a participant you will assume responsibility for your own safety and exercise due care, and must agree to accept this condition. By ticking this box you also indicate that you have read and agree to the ECC terms and conditions of booking.*
I have read and understand the ECC Privacy Policy and consent to my personal details being used for the purposes described.*
Technology. I agree to use technology (eg: cameras, mobile phones, computers, video games, sound equipment, projectors) sensitively and undertake not to take or publish or allow anyone else to publish, in print or online, any images or written accounts arising from this event without first obtaining the permission of the people represented within them.*
Signed* Date*