Long Term Conditions Forum Launch Event

Thank you for registering your interest in this event. Please complete the form. If you experience any difficulties, contact 01482 665684.

Your full name(Required)

Your age(Required)

If under the age of 16, parent/carer/guardians full name, email and contact number (this person will need to attend the event with you)

First half of your home postcode(Required)

For example SW1 9SZ would be SW1

Your contact number(Required)

Your email(Required)

Please indicate your long term health condition(Required)

Do you require any reasonable adjustments and/or have accessibility requirements?

Please confirm you are able to attend 31st October 2024 11am until 3pm(Required)

YesNo

The event is being held at Hull CVS, 75 Beverley Road, Hull HU3 1XL.

Please indicate if you have any dietary requirements

Please check this box to confirm you understand you must wait to be contacted with confirmation of a place(Required)

I have read and understand

I am unsure, please contact me to explain

Spaces are limited. We aim to contact as soon as possible to avoid any disappointment

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