ASI Wise Delegate Learning Needs.
This form is shared GDPR regulations required in the EU. If at any time you wish to be removed from our database, please contact us via hello@asi-wise.org. We will respond within 7 working days. Please do not use an NHS or organisation email as these can easily be blocked by large organisation spam filters.
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Email *
Your preferred name and surname *
This is the name that will appear on your certificate of attendance.
Mobile Phone Number *
This number will be used to contact you about your learning needs should we require further information
Do we have consent to share your details with the workshop/modules instructors and tutors? If you say no, we will not be able to accommodate your additional learning needs. *
What is you profession? *
Which Module will you be attending? *
My module/workshop starts on (day 1): *
MM
/
DD
/
YYYY
More about me and my learning needs *
Required
The reasonable accommodation that will help support my learning on this module or workshop include... Please include any reasonable accommodations and adjustments you have at work. *
A copy of your responses will be emailed to the address you provided.
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