Workshop Request Form - ONE form to be completed per workshop

Before filling in the workshop request form please take some time to read the

terms and conditions for Workshop Organisers

Section 1 – Organiser Information
Your name:
Organisation:
Organisation address:
Role/job title:
Daytime telephone number:
Email address:
Will you be present at the workshop to meet and greet?
/ Yes / No
If not, please provide the name of the person that will be present:
Out of hours mobile number for that person (to be used by tutor in emergency):
Is the course? / Closed for your own targeted group and not to be advertised
Open to accept bookings from the general public
Please provide contact details for the person taking the bookings if different from above
Name:
Telephone number:

Section 2 Invoice details

If your organisation is not responsible for paying for this workshop please provide additional details here: Payment will need to be made to Glyndŵr University
Full Organisation name (to appear on the invoice):
Full Organisation address inc. postcode (to appear on the invoice):
Do you need to provide a purchase order number for your finance department (this will appear on the invoice) / Yes / No
If yes, please quote your purchase order number here:

Section 3 Workshop details

Workshop date and time: (We will always endeavour to find a tutor for your 1st choice date, however this is not always possible so please provide alternatives below). You must provide a minimum of 4-6 weeks’ notice

Workshop Title:
1st choice workshop date: / 2nd choice date: / 3rd choice date:
Start time: / End time:
Do you require us to allocate a tutor / Yes / No
If no, please provide the name of the tutor you have allocated to the course.
Workshop venue (must be full address incl. post code):
Has the venue been approved by Sport Wales?
If no, we will need to send you a ‘workshop venue checklist form’ which you will need to fill in & return to us (by post or email) before a workshop can be booked. / Yes / No
Estimated number of attendees:
(10 min – 24max except for SGPC: 20 max)
Target audience:
Resource delivery address (must be full address inc. post code):
Equipment (This equipment must be provided for all workshops, please tick to confirm it will be available)
Laptop and data projector/screen / OHP and screen
Flipchart, paper and pens (preferred) / Black/White board and chalk/pens

Please sign and date below. Request forms will not be accepted without this.

I confirm that our requirements are as stated on this form and that I have read and agree to the terms and conditions.

Signed (Workshop Organiser) Date:

Updated Oct-16