| Your name and contact details | |
| First Name* | Surname* |
| Address* | |
| 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: |
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| Some useful information for us | |
| I have been to an ECC event before* |
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| If yes, where and when was the last one? | |
| I heard about ECC from |
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| Travel to the event | |
| I plan to travel to the event by
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| I would like a lift if possible: |
I can offer a lift: If so, for how many people? |
| Event information | |
| I may be interested in facilitating a base group |
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| I may be interesting in organising the following workshops: | |
| I have the following particular needs (rather than preferences): | |
| Meal option: Butternut squash and lentil Wellington |
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| Meal option: Carrot Wellington with spiced marmalade |
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| 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? |
| Payment Concessionary rate £250.00, Low income £510.00, Average income £610.00, High income £690.00 | |
| The total amount I will pay for the event is* £ which is a minimum 25% of the total amount Please make cheques payable to Edward Carpenter Community Ltd (full words please) |
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| Booking conditions Please tick to indicate you accept all the terms, and sign and date the form* | |
| Signed* | Date* |
| Add any other comments | |