Booking Form at Hope UK

General Information:

Date:
Contact Name:(required)
Organization:
Contact address:(required)
Post Code:(required)
Day Tel No:(required)
Eve Tel No:(required)
Email:(valid email required)
Fax no:

Choice of dates:

First choice:(required)
Second choice:(required)
Third choice:
Start and finish time of group:(required)
Start and finish time of Drug Educator:(required)

Other Details:

Age of group members:(required)
Size of group expected:(required)
What would you like the Drug
Educator to cover in the time
available:
Are there any members of the
group with special educational
needs or any other issues the
Drug Educator needs to be
sensitive to?(required)
Has the group already had some teaching
on the subject, either in your group or elsewhere?
No Yes
If Yes, please give details:
Is the group used to structured
activity and discussion?(required)
Description of venue
(i.e. small lounge/large hall etc)?(required)

Equipment available:

Laptop Projector DVD OHP Flipchart+stand
Address and directions to venue
plus recommended method
of transport?(required)
Drug Educator: (Office use only)

cforms contact form by delicious:days

If you would like to download a PDF version of the form above, RIGHT-CLICK HERE (then select “Save Link As” to download into your computer) and send it to the following address:

Hope UK
25 (f) Copperfield Street
London
SE1 0EN
Tel: 020 7928 0848
Fax: 020 7401 3477
Website: www.hopeuk.org
E-mail: d.devine@hopeuk.org

Hope UK

Booking Form

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