Booking Form

DLGN – IDS Learning Retreat on civic engagement and socially inclusive service delivery2-5 September 2014 at IDS, Brighton

This form must be completed and returned to by Monday 30th June, midday – we will contact you within a weeks to confirm your booking, but for non-DLGN members we will need to receive paymentbefore your place will be guaranteed. Participants are advised to not make travel bookings before they havereceived a confirmation of their booking from IDS.

Personal Details
Title: Dr/Mr/Mrs/Ms/Miss/Other (please specify)
Surname/Family name:
First Names (in full):
Male: Female: / Date of Birth:
(dd/mm/yy)
Address: / Mobile No:
Landline No: / Email:
Next of Kin Details:
Disability Requirements (any specific requirements):
Please list any Dietary Restrictions/Preferences:
Current Employer/Organisation:
Current Employer/Organisation Address:
Current Role/Position: / How long have you been in your current role?
Are you a member of the DLGN Network? Yes: No:
Please briefly describe your current/expected duties and responsibilities:
Please list your educational background and/or professional qualifications:
Visa details
Do you need a Student Visitor visa to study in the UK?* Yes: No:
If yes please complete the section below
Which is the nearest British embassy you will be applying to?
Nationality( as stated in your passport)
Passport Number: / Passport Expiry Date:
(dd/mm/yy)
Name ( as it appears on your passport)

* Please note it is your responsibility to obtain a visa, IDS can send you a supporting letter.

Learning Retreat Details
Describe how this Learning Retreat might help your current/future role:
How many years have you been in professional service?
Have you secured funding for the course fee (£1,000 Non-DLGN members only)?
If yes please provide details of funder including contact details:
Where did you hear of this Learning Retreat?
By signing this booking form you are confirming that all the information is correct
Signature:
(type name if submitting electronically without an e-signature)
Date:

Please note that in the unlikely event that we have to cancel the short course, we reserve the right to cancel the course four weeks before the course commences. In case of cancellation, any course fees paid will be refunded. IDS will not be liable for any costs incurred with respect to any travel or accommodation bookings. It is therefore advisable to book accommodation and travel that is refundable should we have to cancel the course.

DLGN – IDS Learning Retreat: Civic engagement and socially inclusive local governance

2-5 September 2014