On-line Booking Form

complete on-line form here


Name:
Address for correspondence:*
Work Address (if applicable):*
Telephone day::*
Telephone evening::*
Special diet:*
Disabilities we need to be aware of: :*
Access issues we need to be aware of::*
Any other requirements::*
I am happy for my contact details to be shared with other delegates at the conference:*
yes
no
I am happy for my contact details to be entered onto the hospice23 database and be kept informed of future events:*
yes
no
Accommodation:*
single £275
shared £220
Day Delegates:*
Friday £50
Saturday £80
Sunday £50
N/A
Deposit or Day Fee : Account: 33146774 : Sort Code: 20-79-73:*
Deposit
Friday
Saturday
Sunday
Please enter the verification number on the right:*
one two one one one
* Required Fields

Flyers and booking information
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