Level Playing Field 'Midlands Forum' registration form for clubs and organisations

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* 1. First name

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* 2. Last name

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* 3. Contact e-mail

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* 4. Contact phone number

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* 5. Please let us know if you have any access requirements (e.g. interpreter, large print text, subtitles)

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* 6. Will you be bringing a companion/PA?

Yes

No

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* 7. Which club or organisation are you representing?

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* 8. Do you or your companion/PA have any dietary requirements, including any allergies? (please list all)

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* 9. Do you require parking?

Yes (accessible parking)

Yes (general parking)

No

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* 10. If you require parking, please provide your vehicle registration number

If you would like to know more about becoming a free Level Playing Field member, then please click this link