Members Weekend 2022
Application Form
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Email *
PERSONAL DETAILS
Your Name: *
Membership No.: *
Address: *
Email Address: *
Telephone Number: *
Next of Kin Name: *
Next of Kin Telephone Number: *
Will you be bringing a guest / carer? *
Your Guest Name:
Is your guest a carer or spouse?
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ACCOMMODATION AND MEALS
(Meals included are - Saturday: Dinner; Sunday: Breakfast, Lunch and Dinner; Monday: Breakfast)
Type of Accommodation *
If you are attending with your carer, do you require an additional room?
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Which nights will you be staying? *
Required
If accommodation is NOT required OR you are staying for ONE night, please tick which meals are required.
Please indicate below if YOU (Member) have any dietary requirements or allergies? *
Please indicate below if YOUR GUEST / CARER has any dietary requirements or allergies? *
MOBILITY
* Please note wet rooms are very limited and will be allocated to Members with the highest needs. Your BSO will call you to discuss your specific needs and your request for bathing aids.*
Do you require a wet room or lowered bath? *
Do you need Blesma to supply bathing aids? *
Are you bringing a wheelchair? *
If yes, please indicate the size / type of wheelchair.
ACTIVITIES
A range of activities will be offered on the Sunday afternoon and will be determined at a later date.  

If you have any activity ideas or suggestions you would like to propose, please indicate them below.
Activity Suggestions / Ideas:
Are you willing to instruct / lead your suggested event?
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