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 thpdp@towerhamlets.gov.uk. 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 thpdp@towerhamlets.gov.uk