Please reserve a place for me on
Introduction to the theory of permaculture design

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
Dates* Saturday 26 and Sunday 27 July 2008
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  £140
Individual waged less than 18k/yr  £80
Individual income 18-25k/yr  £110
Individual income more than 25k/yr  £140
Individual, concession rate  £50
Other fee   Agreed with 
I also wish to give Brighton Permaculture Trust a donation of 
  
 
 
 
*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 attending the course/event:

Your email address   yes no
Your postal address 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 full time (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