RNIB Training Event Booking Form

RNIB training event booking form

This form contains 28 questions and should take around 10 minutes to complete.

Event details:

Please enter the details of the course on which you wish to book at the end of each line.

1.  Title: Exams Update Day

2.  Date: Tuesday 16 January 2018

3.  Venue: RNIB, Judd Street, London

4.  Fee: £40 (£30 for VIEW members)

Your details:

Please provide your personal details below. Type your answer at the end of each line.

5.  Surname:

6.  Title (Mr / Mrs / Ms / Miss / Dr /Other - please specify):

7.  Forename:

8.  Address including postcode:

9.  Address type: Home / work / other (please specify):

10.  Telephone (work):

11.  Telephone (home):

12.  Mobile telephone:

13.  Email address:

14.  Job title:

15.  Employer name:

16.  Purchase Order reference:

17.  Are you a VIEW member: Yes / No

18.  Invoice address if different (please include postcode):

19.  Invoice contact name:

20.  Invoice contact telephone number:

Individual requirements:

21.  Please state your preferred reading medium: standard print (Arial 14), large print, braille, audio CD, email:

22.  If large print, please state font size:

23.  Any dietary or access requirements? Please state Yes or No:

24.  If Yes, please specify:

How did you hear about this course?

25.  Please indicate if course flyer, RNIB website, Insight Online, VIEW website, word of mouth, specialist magazine, email or other:

26.  If other please tell us:

Data protection:

27.  RNIB would like to stay in contact with you to let you know more about our news, services and how you can support the work we do.

Please indicate your preferences below (please state Yes or No):

·  I want to hear from you by email:

·  I want to hear from you by mail:

·  I want to hear from you by text:

You can tell us at any time that you no longer want to hear from us by calling us on 0303 123 9999 or emailing us at

28.  Please tell us which category best describes you (please state Yes or No):

·  Blind or partially sighted individual:

·  Friend, family or carer:

·  Professional:

·  Other (please state):

Thank you!

Please return completed forms to Michelle Broadhurst:

Email:

Telephone: 024 7636 9500

Bookings will be acknowledged within 5 days of receipt.

[form ends]

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