Online Enquiry Form

I wish to reserve my delegate place at the NAEP National Conference 2012

Please note we do not encourage and reserve the right to refuse bookings for delegates from commercial organisations.

Please Note If you are booking as a NAEP member please ensure that your membership is up to date. The organisers will monitor all bookings to ensure that all membership details quoted are valid.

All fields marked with * are Mandatory

Your Details

* Title:
* First Name:
* Surname:
* Job Title:
* Organization:
Address1:
Address2:
City:
Country:
* Postcode:
* Telephone:
Fax:
* Email:
Access / Dietary Needs:
Please include your 2 choices of workshop here and if booking a one day package, which day you are booking for
Please indicate your first and second choice of Innovation Through Learning session (please note these take place only on Thursday 21 June)	Session 1 Session 2

Please tick the box that describes your overall responsibility:

	Equipment Manager		Finance/IT/Admin
	Operations/Stores/Procurement		Voluntary Sector Worker
	OT/Clinical Lead		Retailer
	Commissioning Lead		Other

Do you have any budget responsibility?

Yes

Delegate Type (Please tick which rate applies to you)

	* Non Member		* NAEP Member
*NAEP Membership Number (please state)

Conference Packages and Fees

NAEP MEMBERS Conference Packages and Fees

Please tick the relevant box to indicate the package you would like to book
	Two night residential package. Includes entry to the conference, lunch and refreshments on 19th, 20th and 21st June. Two night’s accommodation at the Norbreck Castle Hotel for 19th and 20th June, with breakfast, and entry to the conference dinner on the evening of the 20th June EARLY BIRD COST – £200.00 (Plus VAT)

	One night residential package. Includes entry to the conference, lunch and refreshments on the 20th and 21st June. One night’s accommodation at the Norbreck Castle Hotel for the 20th June, with breakfast, and entry to the conference dinner on the evening of the 20th June EARLY BIRD COST – £183.00 (Plus VAT)

	Attendance for Three Days - No Hotel: Includes entry to the Conference on 19th, 20th and 21st June with lunch and refreshments for both days. Please Note: entrance to the Gala Dinner is not included in this package. For information on purchasing Gala Dinner tickets please contact the Conference Event Team at Disability North EARLY BIRD COST – £167.00 (Plus VAT)

	One day delegate package. Includes entry to the conference lunch and refreshments on specified day. Please state below which day you wish to attend: 19th June 20th June 21st June EARLY BIRD COST – £128.00 (Plus VAT)

NAEP NON MEMBERS Conference Packages and Fees

Please tick the relevant box to indicate the package you would like to book
	Two night residential package. Includes entry to the conference, lunch and refreshments on 19th, 20th and 21st June. Two night’s accommodation at the Norbreck Castle Hotel for 19th and 20th June, with breakfast, and entry to the conference dinner on the evening of the 20th June COST – £292.00 (Plus VAT)

	One night residential package. Includes entry to the conference, lunch and refreshments on the 20th and 21st June. One night’s accommodation at the Norbreck Castle Hotel for the 20th June, with breakfast, and entry to the conference dinner on the evening of the 20th June COST – £265.00 (Plus VAT)

	Attendance for Three Days - No Hotel: Includes entry to the Conference on 19th, 20th and 21st June with lunch and refreshments for both days. Please Note: entrance to the Gala Dinner is not included in this package. For information on purchasing Gala Dinner tickets please contact the Conference Event Team at Disability North o COST – £248.00 (Plus VAT)

	One day delegate package. Includes entry to the conference lunch and refreshments on specified day. Please state below which day you wish to attend: 19th June 20th June 21st June COST – £182.00 (Plus VAT)

Packages are available for delegates who wish to stay on the 18 or 21 June please contact Norbreck Castle Hotel on 01253 352 341 for more information. Please note the early booking rate only applies until the 31 March 2012.

Please note: Seating at the conference dinner will be randomly allocated unless otherwise stated.

Payment Method

Invoice address (please complete if different to address on delegate registration form).
Address:	Accounts Contact:

Accounts Telephone Number:	Accounts Fax Number:

*Cancellation fees after 30th April 2012 or non attendance will result in no refund.
If you are Interested in receiving details of NAEP as an organization please tick this box.