ASNA Events: Registration Form & Payment Details

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Please use this form to register for the ASNA event you would like to attend. We will send further details once we receive this form. All payments must be made directly into the ASNA account www.asna.info/donate or all cheques sent to

Alma Park Estate

Grantham

Lincolnshire

NG31 9SL

Email *

Please tell us which event you are registering for below *

ASNA Academy: Disability Awareness and Online training (Modular training course 2022)

Here 2 Hear Carers Support Group (Last Friday of the Month carers drop - in meetings 2022)

Carers Creative (Quarterly meeting 2022)

Connecting Carers (& Supporters) Network 29th October 2022

10 day detox for Carers

Other:

Required

First name *

Surname name *

Full Postal Address *

Telephone number *

Age under 18 years or adult *

0-5

6-10

11-17

Adult over 18

Other:

Please tell us about your caring responsibilities if relevant

Please let us know if you have any dietary requirements *

Vegetarian (All meals will be vegetarian)

Vegan

Kosher

Gluten-free

Wheat free

Soya Free

Other:

Required

Please make your payment direct into the ASNA account. Please follow this link for the details of the account www.asna.info/donate. Payment for Carers day for the ASNA members - £25.00, non members £50.00. Please use this code: CCN22 and your initials.

Cheque payments to be sent to

Alma Park Estate

Grantham

Lincolnshire

NG31 9SL

Please update your membership here by following this link https://www.asna.info/plans-pricing

I will make the payment direct into the account and use the code as above

I will make a payment by cheque

I am already a member

I would like to join ASNA (follow this link to join https://www.asna.info/plans-pricing)

I am a volunteer

I am a life long member

Other:

Required

Thank you for sharing your details with ASNA. We do not take this lightly. Please indicate below whether you consent to ASNA keeping your details for ASNA purposes only. Your details will be stored with password protected security. Please let us know if you would like your details to be removed at any time. Your information will be stored for 3 years. *

Yes I consent to my information being stored as indicated above

No I do not consent to my details being stored

Other:

Please indicate below your consent to your image being stored or used for ASNA purposes (such as report writing, funding applications, promotion and marketing on ASNA social media platforms and website). *

Yes I give my consent for my image to be used as above

No I do not give my consent to my image being used for any purposes

I consent to a still image being used for hard copy material

I consent to video images being used as above

I consent to my photo images being used for ASNA hard copy material only

Other:

Would you like ASNA to send you further updates, or details of other ASNA or related events? *

Yes

Maybe later

Other:

Please give us the date today . Thank you *

YYYY

A copy of your responses will be emailed to the address you provided.

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