Birmingham Youth Workshop (Member)

If you wish to book online for multiple attendees please register each user separately. Alternatively contact head office on 01462 455016 or [email protected] for further booking information.

Salutation *
Mr.Mrs.MissDr.Ms.Prof.Rev.LadySirCapt.

Forename *

Surname *

Profession

House Number/Street/Business Name *

Address 2

Address 3

Town *

County *

Postcode*

Country

Telephone*

Your Email*

Please indicate any special dietary needs:

If you have a disability or additional needs and require assistance in order to fully participate in this event,
please tick here. You will be contacted by a member of staff to discuss your specific needs. Yes

Keep in touch Yes
Please tick if you agree to receiving further information from the Dyspraxia Foundation with relevant news, webinars, surveys and events.
Note: Personal contact details provided by you will be held on a database for the purposes of administrating the conference.

In order to attend an Dyspraxia Foundation Youth Event, we require additional information in case of emergencies. Please fill in the details of someone we can get hold of on the day of the event you are attending. If you have any questions then please contact us.

Medical Needs * (Please make us aware of any medical needs you might have in case of an emergency)

Name of Emergency Contact

Relation to you *

Salutation *
Mr.Mrs.MissDr.Ms.Prof.Rev.LadySirCapt.

Forename *

Surname *

Telephone*

Email

Our payment provider for this conference is PayPal. Please press continue above to be transferred to PayPal to pay for your place at our event. A valid receipt from PayPal is confirmation that your place has been reserved at the event.