Local Wellbeing Conference

Register

NB: Fields marked [req] must be completed.

Please complete the form below and click "Submit" to register. You will be issued with a receipt of registration and an invoice within three working days.

Your Details

Title: [req]

First Name: [req]

Surname: [req]

Position: [req]

Organisation: [req]

Organisation Type: [req]

Address: [req]

[req]

Post Code: [req]

Tel no: [req]

Fax no:

Email: [req]

Confirm Email: [req]

Where did you hear about this event?: [req]

Other
(please specify):

Please check the boxes below if you would like to receive a complimentary copy of:

Public (Guardian's monthly magazine)

The MJ and Local Government News

Data Protection

The event organisers may wish to contact you with information on this or closely related subject matters. This information will not be given to any third parties for commercial purposes. If you would like to receive such information please cross the box.

Event sponsors may wish to contact you with information on this or closely related subject matters. If you would like to receive such information please cross the box.

Specific Needs Information

If you require vegetarian food, please tick the box

If you have other dietary requirements (allergies, gluten free, vegan, etc) please tick the box and we will contact you

If you have additional specific requirements (mobility, sight, hearing, etc) please tick the box and we will contact you

Payment Details

In order that your invoice / payment may be dealt with promptly, please state your purchase order number below:

Account code / Purchase order:

Credit / Debit Card payments: If you would like to pay by credit card please contact us on +44 (0)1772 767736 and we can take your card details by telephone.

Terms and conditions
The conference fee needs to be paid in full prior to day of the event to guarantee access on the day. If you need to cancel your place at the conference, the event organisers must be informed in writing (email is acceptable). Cancellations up to 30 days prior to the event will be subject to a charge of 20% of the delegate fee. Later cancellations will not receive any refund. Named substitute delegates may be accepted. Full contact details of substitute delegates should be submitted at the time of cancellation.

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