PDP-Event-Booking-form

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Tower Hamlets Pan-Disability Panel Enrolment Day Event
BOOKING FORM
The Brady Arts & Community Centre 192-196 Hanbury Street, E1
12th November 2009, 10am- 4pm
Your details:
I would like to attend the event
(please tick a box)
Yes
No
I am unable to attend but would like to receive
information
(please tick a box)
Yes
No
Are you a:
Dr
Mr
Mrs
Ms
Other (Please say)
(please tick a box)
First Name:
Surname:
Address:
Postcode:
Telephone:
E-mail:
(Please write your e-mail clearly as confirmation will be sent by e-mail)
If you prefer confirmation by post please tick box:
If you already have an interest in one of Prosperous Community
the areas, please tick a box. You can still Safe and Supportive Community
make a decision on the event day.
Healthy Community
Great Place to Live
Transport
Please specify any dietary or access requirements:
Please return this completed form by 26th October’09 to: Farhana Khan, London Borough of
Tower Hamlets, Scrutiny & Equalities Team, Chief Executive’s Directorate, 6th Floor, Town Hall,
Mulberry Place, 5 Clove Crescent, London E14 2BG. or by email to [email protected]
Your attendance will be confirmed by return.
If your attendance is not confirmed by 31st October 2009 please telephone 020 7364 5980/5347 or
email to [email protected]
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