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Course you wish to attend*
Date of course you wish to attend:
DD slash MM slash YYYY
Name of person booking course:*
Job Title & Workplace:
Address of person booking course:
Street Address Address Line 2 Town / City County Post Code
Contact Email:*

Name or names of those you wish to attend (this may be you or it may be that you are booking your staff on the course):*

Name	Job Title

Special dietary requirements of those attending:
Payment
I wish to pay by:
- Cheque - Rowans Hospice will be in touch with you to organise payment by cheque
- I request an invoice - please enter details below
Please mark an invoice for the care of:
Email or post invoice to:
Please enter a valid email or postal address for us to send an invoice to.
If you require a PO number please add this here:
Marketing Information
How did you discover the Charity's training and education web page?*
- Social Media
- Internet search engine e.g. Google
- Previous course facilitator
- Workplace/Colleague
- Leaflet
Data Protection Statement
We use personal information to process your application, to thank you for supporting us and to provide you with further communications about our news, events, products and activities. Our full Information Notice can be viewed here. If you would prefer to receive this information, or not at all, please tick the appropriate box below.
- Please send me information by email
- I would prefer not to receive anything
Use of photography*
I accept that there may be a member of Rowans Hospice staff taking photos during the course for future use in brochures, on the website or on social media, and that I must let the event facilitator know at the time if I am not happy for my photo to be taken.
I understand that if I am happy for my photo to be taken, I will be given a permission form to complete and sign to confirm this.
- I accept

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Newsletter Sign Up

We'd love to tell you about the latest news and fundraising activities through our 6-monthly magazine Reaching Out, as well as our regular fundraising e-newsletters, mailings and raffle tickets.

You can choose to keep in touch either via post or email below.
Title*
Your Name*
First Last
Please tell us what you would like to receive and how:*
- Reaching Out by email
- Reaching Out by post
- Fundraising mailings by email
- Fundraising mailings by post
- Raffle mailings by email
- Raffle mailings by post
Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Please see how we use your personal information to provide you with communications about our news, events, products and activities, in our full Information Notice here.
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