Course details Monitoring Course date To help us work towards fair representation, please answer the following questions: Course title Do you identify yourself as being: White British Course code (if known) Irish Closing date for the course Any other White background Your details Mixed race White & Black Caribbean Male Female Other White & Asian Surname Any other Mixed background or First name Asian British Indian Membership no. Pakistani Branch Any other Asian background Black & Service group (e.g Health, Local Gov) Black British Caribbean African Address for correspondence Any other Black background Chinese or other ethnic Chinese Contact no. group Any other ethnic background Mobile Please provide your email address below so Other Mixed we can send joining instructions by email: Heritage Email ---------------------------------------------------------------- All applications must ask their Branch Facilities Secretary/Branch Education Officer to complete this section. Any problems should be Do you have special dietary Yes / No referred to the Regional Education Officer on Are you disabled? Yes / No 01483 406502 Do you have any access needs? Yes / No Important note: please ensure membership Do you need assistance with numbers of all applicants are on all child/dependent care to attend application forms to assist with administration. this course? Yes / No If you have answered yes to any of the above This application is supported by the Branch please give details: Signed Date _______________________________________ Branch position _______________________________________ Return to: Lucy Stubbs PLACES ON COURSES CANNOT BE UNISON South East, Ranger House, GUARANTEED THEREFORE YOU ARE ADVISED Walnut Tree Close, Guildford, Surrey GU1 4UL NOT TO MAKE TRAVEL/HOTEL ARRANGEMENTS fax to: 01483 570271 UNTIL A PLACE HAS BEEN CONFIRMED Email to:
Course details Course date Course title Course code (if known) Closing date for the course Your details Male Female Other Surname First name Membership no. Branch Service group (e.g Health, Local Gov) Address for correspondence Contact no. Mobile Please provide your email address below so we can send joining instructions by email: Email Facilities Do you have special dietary Yes / No Are you disabled? Yes / No Do you have any access needs? Yes / No Do you need assistance with child/dependent care to attend this course? Yes / No If you have answered yes to any of the above please give details: _______________________________________ _______________________________________ PLACES ON COURSES CANNOT BE GUARANTEED THEREFORE YOU ARE ADVISED NOT TO MAKE TRAVEL/HOTEL ARRANGEMENTS UNTIL A PLACE HAS BEEN CONFIRMED Monitoring To help us work towards fair representation, please answer the following questions: Do you identify yourself as being: White British Irish Any other White background Mixed race White & Black Caribbean White & Asian Any other Mixed background or Asian British Indian Pakistani Any other Asian background Black & Black British Caribbean African Any other Black background Chinese or other ethnic Chinese group Any other ethnic background Other Mixed Heritage ---------------------------------------------------------------- All applications must ask their Branch Secretary/Branch Education Officer to complete this section. Any problems should be referred to the Regional Education Officer on 01483 406502 Important note: please ensure membership numbers of all applicants are on all application forms to assist with administration. This application is supported by the Branch Signed Date Branch position Return to: Lucy Stubbs UNISON South East, Ranger House, Walnut Tree Close, Guildford, Surrey GU1 4UL fax to: 01483 570271 Email to:
Regional-Course-Application-Form-June-2018.docx