Fruit tree grafting reservation form

Please reserve a place for me on
Fruit tree grafting

Saturday 9 August 2008

Please read the course/event information before reserving a place

Please fill in this form as fully as you can (one for each applicant). We will then email to confirm your reservation and ask for payment within three days by cheque/postal order or by credit card through PayPal. If you do not receive an email please check your spam or junk email folder (especially Hotmail account holders). A place is not secured until we have received the requested payment.

*These items are required

First name*

Family name*

Name by which you like to be known

Address 1*

Address 2

Address 3

Town/city*

County

Postcode*

Day phone*

Evening phone*

Mobile

Fax

Email*

Please say if you can or cannot receive emails immediately prior to the course/event

Fee options* - please indicate which option you are applying for:

Sponsored/organisation rate

£115

Individual income more than 25k/yr

£115

Individual income 18-25k/yr

£90

Individual waged less than 18k/yr

£65

Individual, concession rate

£40

Other fee

Agreed with

I also wish to give Brighton Permaculture Trust a donation of

Concessionary rates are available to people in receipt of means tested benefits, students & OAPs. If you are claiming the concessionary rate, please give your reason and state benefit number if relevant

*In case of an emergency, whom do we contact for you? Name and telephone number please.

Do you consider yourself to be disabled?

Do you consider yourself to have a learning difficulty?

Do you require additional learning support?

Please describe any conditions/needs of which we should be aware? (eg mobility, medical condition, etc)

Your details will be put on Brighton Permaculture Trust's database and we will email you further details when your place is confirmed. We will not pass your details on to third parties.

May we send you information about other Brighton Permaculture Trust events from time to time?
Yes No

Do you want the following contact information to be shared with others attening the course/event:

Your email address	yes	no
Your postal addrees	yes	no
Your daytime phone number	yes	no
Your evening phone number	yes	no

The information in the next section is not essential, but helps us to adapt courses/events to meet peoples needs, widen participation for different people in the area, and may help us to get funding. But please confirm your application at the bottom of the page

My gender

male female

My year of birth

My employment status

registered as unemployed (seeking work)

unwaged (not seeking work, including retired)

employed part time (including self employed)

employed ful ltime (including self employed)

a full time student

My ethnicity
Pakistani	Black African	White British	Mixed (White & Black African)
Indian	Black Caribbean	White Irish	Mixed (White & Black Caribbean)
Bangladeshi	Black (other)	White other	Mixed (White & Asian)
Chinese			Mixed (other)
Asian (other)

Another ethnicity (please state which)

How did you hear about this course/event (choose one)?

Direct BPT emailing		BPT poster		BPT leaflet
Word of mouth		Web search eg. Google

Magazine listing - please state which one

Web listing - please state which site

Other email list/group - please state which list/group

Other please say how

Can't remember

Which related courses/events have you attended? (Eg other permaculture courses, organic gardening, community building)

What other related knowledge/experience do you have?

What are your reasons for joining / what do you hope to get out of it?

I have read and understood the course/event information *

I accept the conditions stated in the course/event information and on this form *

The details I have given are correct to the best of my knowledge *

Please check your details then click the button below to send in your application. After clicking 'send' you will be taken to a page confirming that we have received your reservation. If you do not see this page your reservation has not been sent.

In the event of problems with your application/booking please contact us or leave a voice message on 07746 185927