Beat SCAD Conference Saturday 9 June 2018 Booking Form
Please complete this registration form to guarantee your place for the Beat SCAD Conference at the Queen Elizabeth Hospital, Birmingham.

The delegate fee is £30 and once you have completed the form you will be directed to our online shop to pay. Please note your place is not guaranteed until you have paid the delegate fee(s).

Thank you

The Beat SCAD Team

Email address *
Full name *
Your answer
Postal address *
Your answer
Contact phone number *
Your answer
Please confirm your email address *
Your answer
Please provide details of everyone in your party who will attend the one-day Conference.
Number of delegates attending the Conference on 9 June *
Name of Delegate 1 *
Your answer
Is Delegate 1 a SCAD patient?
If Delegate 1 is a SCAD patient, please add the year(s) of their SCAD(s)
Your answer
Name of Delegate 2
Your answer
Is Delegate 2 a SCAD patient?
If Delegate 2 is a SCAD patient, please add the year(s) of their SCAD(s)
Your answer
Name of Delegate 3
Your answer
Is Delegate 3 a SCAD patient?
If Delegate 3 is a SCAD patient, please add the year(s) of their SCAD(s)
Your answer
Name of Delegate 4
Your answer
Is Delegate 4 a SCAD patient?
If Delegate 4 is a SCAD patient, please add the year(s) of their SCAD(s)
Your answer
Name of Delegate 5
Your answer
Is Delegate 5 a SCAD patient?
If Delegate 5 is a SCAD patient, please add the year(s) of their SCAD(s)
Your answer
Do any of the conference delegates have special dietary requirements? Please list below
Your answer
Do any of the delegates have special assistance requirements? Please list below
Your answer
We are exploring options for an evening meal on Saturday 9 June after the Conference. The cost of a meal will be separate from the conference delegate fee. This is purely an expression of interest and, if organised, you will be contacted about the venue, menu and costs before confirming participation. Would you be interested in attending this?
If Yes, how many people will be in your party for an evening meal?
We are considering having a walk on the morning of Sunday 10 June. There will be no cost associated with attending a walk. Would you like to take part?
If Yes, how many people will be in your party for a walk?
Permissions
Beat SCAD will be taking photos and audio/video at the Conference. If you do not want to be included in this material, please make yourself known at the Registration desk so we can seat you appropriately.
Please check the boxes below
Please confirm you are happy for us to contact you about this Conference, and possible walk and dinner. We may contact you after the event to ask for feedback. We will never share your details with anyone else and you can change your mind at any time.
Please let us know how you would like to hear from us about this Conference, and possible walk and dinner.
Post-SCAD successes - we want your photos!
Last year we had an 'Inspiration Board' where delegates pinned messages about their achievements since SCAD. This year, we'd love to have photos of delegates showing their achievements, how far they've come since their event and how their lives have changed or improved. If you would like to be featured on our Inspiration Board, please send a photo to contactus@beatscad.org.uk or bring one along on the day!
Further information
If there is any other information you would like us to know, please email us at contactus@beatscad.org.uk, putting 'Conference 2018' in the title field.
Paying the delegate fee
The delegate fee is £30 per person for the one-day Conference.

Once you click 'Submit' on this form, you will be provided with a link to our online shop in order to pay for your delegate place(s). You will need to choose the number of tickets you require and then pay via credit or debit card.

PLEASE NOTE THAT YOUR PLACE IS NOT CONFIRMED UNTIL WE RECEIVE PAYMENT.

Thank you for registering - see you in June!
A copy of your responses will be emailed to the address you provided.
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