This is the sign up form for non-members of the Dyspraxia Foundation who want to attend our Youth Event in Birmingham on 12th October 2019.

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 *

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.

Name of Emergency Contact

Salutation *

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.

Cancellation Policy
Cancellations received in writing no later than Friday, 11th October will receive a full refund less £10.00 administration charge. No refunds are possible after this date but substitutions are welcome at any time; however an administration charge of £5.00 will be levied

Data Protection
The personal information provided by you will be held on a database. It may be used to keep you up to date with future events or developments