Registration - RUSI & LTN Annual Security Event Survey

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Your details:
Salutation

	Please select:
Title:	Your details: Salutation Title: Please select:

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First Name:

First Name:

*
Surname

Surname

*
Job Title:

Job Title:

*
Telephone:

Telephone:

*
Email address:

Email address:

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Organisation Details:
Name of Organisation:

Organisation Details:

Name of Organisation:

*

Address:

Address:

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Size of organisation:

	Please select:
Size	Size of organisation: Size Please select:

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How did you hear about this event?

How did you hear about this event? From a colleague (Please specify below)

Association (Please specify below)

Direct from LTN

Website/ General Enquiry

Twitter

Linked In

Please specify

Please indicate up to THREE categories which illustrate your interest area

Please indicate up to THREE categories which illustrate your interest area Information Security- to include cryptography, network security, antivirus

Sensors and surveillance.-to include sensor networks, CCTV, image/video analytics, geographical information/positioning systems

CBRN - chemical, biological, radiological, and nuclear hazards (relates to Security)

Medical Devices

Infect-Immun - Infectious & Inflammatory Diseases

Cyber Security

As a beneficiary of RDA funding we are required to gather information on the ethnicity, gender, disability and ownership of all attendees of LTN’s networking events and training seminars.

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About Your Organisation
How would you define the primary ownership of your company? The question refers to ownership of the company only, and not the person signing. You may tick more than one box, and the information you provide is strictly confidential.

About Your Organisation

How would you define the primary ownership of your company? The question refers to ownership of the company only, and not the person signing. You may tick more than one box, and the information you provide is strictly confidential. BAME (Mixed, Asian or Asian British, Black or Black British, Chinese or other Ethnic groups).

Woman

Disabled

None of the above

Would rather not say

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About You
Gender:

About You

Gender: Male

Female

Would rather not say

*
What is your ethnic group?

What is your ethnic group? British Irish Caribbean African Indian	Pakistani Chinese Other Would rather not say
Other (please specify)

Would you consider yourself disabled?
(Under the definition in the 1995 Disability Act – i.e. a physical or mental impairment which has a substantial and long term adverse effect on the ability to carry out day to day activities)

Would you consider yourself disabled? (Under the definition in the 1995 Disability Act – i.e. a physical or mental impairment which has a substantial and long term adverse effect on the ability to carry out day to day activities) Yes

Would rather not say

Do you need any additional requirements at the event?

Do you need any additional requirements at the event? Yes

Please specify:

LTN confirms that all information disclosed will be treated in the strictest confidence unless all parties give permission for publicity.

LTN is funded by the UK Government, the European Union, the London Development Agency, South East England Development Agency and East of England Development Agency.

Registration - RUSI & LTN Annual Security Event

*Your details: Salutation

*First Name:

*Surname

*Job Title:

*Telephone:

*Email address:

*Organisation Details: Name of Organisation:

*Address:

*Size of organisation:

*How did you hear about this event?

Please indicate up to THREE categories which illustrate your interest area

*About Your Organisation How would you define the primary ownership of your company? The question refers to ownership of the company only, and not the person signing. You may tick more than one box, and the information you provide is strictly confidential.

*About You Gender:

*What is your ethnic group?

Would you consider yourself disabled?(Under the definition in the 1995 Disability Act – i.e. a physical or mental impairment which has a substantial and long term adverse effect on the ability to carry out day to day activities)

Do you need any additional requirements at the event?

*
Your details:
Salutation

*
First Name:

*
Surname

*
Job Title:

*
Telephone:

*
Email address:

*
Organisation Details:
Name of Organisation:

*

Address:

*
Size of organisation:

*
How did you hear about this event?

*
About Your Organisation
How would you define the primary ownership of your company? The question refers to ownership of the company only, and not the person signing. You may tick more than one box, and the information you provide is strictly confidential.

*
About You
Gender:

*
What is your ethnic group?

Would you consider yourself disabled?
(Under the definition in the 1995 Disability Act – i.e. a physical or mental impairment which has a substantial and long term adverse effect on the ability to carry out day to day activities)