Course details Monitoring Course date 20 September 2017 To help us work towards fair representation, please answer the following questions: Course title New Stewards Network & Follow Do you identify yourself as being: Up Training Day 2017 Course code (if known) n/a White British Irish Closing date for the course 6 September 2017 Any other White background Your details Mixed race White & Black Caribbean Male Female White & Asian Surname Any other Mixed background Asian or First name British Indian Membership no. Pakistani Branch Any other Asian background Black & Service (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 ---------------------------------------------------------------- we can send further information by email: All applications must ask their Branch Secretary or Email Education Coordinator to complete this section. Facilities There is no registration or attendance fee for branches, however branches will need to cover Do you have special dietary needs? Yes / No attendees’ travel and subsistence expenses. Are you disabled? Yes / No This application is supported by the Branch Do you have any access needs? Yes / No Do you need assistance with Signed Date care to attend this course? Yes / No Branch position If you have answered yes to any of the above please give details: Return to: Cath Still UNISON South East, 3rd Floor, Christchurch House, _______________________________________ Beaufort Court, Sir Thomas Longley Road, Strood, _______________________________________ Kent, ME2 4FX Fax to: 01634 717848 PLACES CANNOT BE GUARANTEED. Email to: c.still@unison.co.uk THEREFORE YOU ARE ADVISED NOT TO MAKE TRAVEL ARRANGEMENTS A PLACE HAS BEEN CONFIRMED.
Course details Course date 20 September 2017 Course title New Stewards Network & Follow Up Training Day 2017 Course code (if known) n/a Closing date for the course 6 September 2017 Your details Male Female Surname First name Membership no. Branch Service (e.g Health, Local Gov) Address for correspondence Contact no. Mobile Please provide your email address below so we can send further information by email: Email Facilities Do you have special dietary needs? Yes / No Are you disabled? Yes / No Do you have any access needs? Yes / No Do you need assistance with care to attend this course? Yes / No If you have answered yes to any of the above please give details: _______________________________________ _______________________________________ PLACES CANNOT BE GUARANTEED. THEREFORE YOU ARE ADVISED NOT TO MAKE TRAVEL ARRANGEMENTS 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 Asian or 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 ---------------------------------------------------------------- All applications must ask their Branch Secretary or Education Coordinator to complete this section. There is no registration or attendance fee for branches, however branches will need to cover attendees’ travel and subsistence expenses. This application is supported by the Branch Signed Date Branch position Return to: Cath Still UNISON South East, 3rd Floor, Christchurch House, Beaufort Court, Sir Thomas Longley Road, Strood, Kent, ME2 4FX Fax to: 01634 717848 Email to: c.still@unison.co.uk
Application-Form-New-Stewards-Network-Day-2017-1.docx