Muslim Youthwork Foundation
'Exploring Our Potential' by Sheikha Halima KrausenWorkshop/Seminar: 10th April 2010
Booking Form
Event and Venue Details / Date & TimeMuslim Youthwork Foundation
'Exploring Our Potential'
Concord Youth Centre, Claremount Road, Sparkbrook, Birmingham B11 1LF / Date: 10th April 2010
Time: 10:15am – 16:30pm
Name / E-mail Address / Male/Female
Address / Telephone Number / Mobile Number / Age
Which organisation are you from?
Do you have any special dietary requirements*, access or support needs?
Do you have any allergies or medical conditions you need us to be aware of?
Emergency Contact Name
/Emergency Contact Number(s)
Please tick to confirm you have also sent in the following with this booking form:
Media Consent Form (signed) Cheque/Payment £15.00
Please make your workshop payment of £15.00 to ‘Muslim Youthwork Foundation’
Muslim Youthwork Foundation, PO Box 15649, BIRMINGHAM, B2 2QG, UK
andreturn this form to:
Or alternativelyText/call for further information:
07974497568 /07878283508
Information provided on this form will only be used by MYWF to process your booking. It will not be passed on to any other organisation or individual.
* Please note the food (including all meat-dishes) provided for MYWF will be Halal.
* MYWF may wish to contact you in the future about other events and updates.
*Please tick here if you do NOT wish to be contacted.
Muslim Youthwork Foundation
'Exploring Our Potential' by Sheikha Halima KrausenWorkshop/Seminar: 10th April 2010
Media Consent Form
Muslim Youthwork Foundation (MYWF)plans to use material gathered from this workshop on10thApril 2010. Please fill in this form to let us know if you are happy for photographs, video footage, taped interviews, quotes, articles and information about your experiences with us to be used.
This material will be used by MYWFand its partners in the work we do, including with the media (including press releases), leaflets, posters and website.
If this is a problem, please tell us!
Name
I understand the above and * do / do not wish photographs/video footage where I can be identified, quotes and information about me to be used by MYWF.
Please tick the box(es) that apply to you…
I am happy for MYWF to print my full nameI am happy for MYWF to print my age
I am happy for MYWF to print which organisation I belong to
I am happy for MYWF to print my first name only
I do not want MYWFto share any information about me in their work
I am happy for my contact details to be shared with relevant staff
Any other information/suggestions/comments you would like to add about this:
Signed ______Date ______
If you are under 18,please ask a parent/guardian to sign
here______
*Delete as applicable