Health and Wholeness for All People

Online Booking

 First Name: 

 Surname / Family Name: 

Full Address: 

Telephone number: 

Delegate Options: 
Full Residential Delegate  
Reduced Rate Residential Delegate 
Day Delegate  
Reduced Day Delegate 

Day Delegates - Please indicate the days you plan to attend, including whether you require lunch and dinner or both meals: 

Accommodation Options: 
Single room 
Shared room 
If you wish to share a room with a specific individual please let us know who you would like to share with, otherwise please let us know your gender so that we can make appropriate arrangements: 

Special Requirements:
Please tell us about any special requirements you may have, including dietary or accessibility requirements:

Consent: Please tick all that apply:  

 I consent to the information I provide being stored and processed in accordance with the PRIME Privacy Policy for the purposes of administering the event. I understand that this may mean sharing my name and other information with third parties for example the venue and/or accreditation provide
 I am happy for my name and contact information to be shared with other delegates at this event
I am happy for my photo to be used in PRIME publicity

Data Protection: By completing this form I consent to PRIME recording and storing this information in accordance with the Data Protection Act 1998 and the PRIME Data Protection Statement, available on request. I understand that no details will be released outside PRIME without my express permission. I agree to notify PRIME of any significant changes to this information and/or if I wish to be removed from the PRIME database at any time.