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The Back-Up 1950's Rock 'n' Roll Ball 2010

 

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1. Surname

Surname

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2. First name

First name

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3. Your address

Your address

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4. Contact telephone number

Contact telephone number

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5. Email address

Email address

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6. Are you a wheelchair user?

Are you a wheelchair user?   Yes No

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7. Vegetarian?

Vegetarian?   Yes No

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8. Do you have any other special dietary requirements? (If yes please state)

Do you have any other special dietary requirements? (If yes please state)

9. Please list the names and email addresses of everyone on your table who you have bought a ticket for (Max 10). Please note, it is not to be used to list individuals who you wish to be on a table with.

Please list the names and email addresses of everyone on your table who you have bought a ticket for (Max 10). Please note, it is not to be used to list individuals who you wish to be on a table with.   Guest 1
Guest 1 Email
Guest 2
Guest 2 Email
Guest 3
Guest 3 Email
Guest 4
Guest 4 Email
Guest 5
Guest 5 Email
Guest 6
Guest 6 Email
Guest 7
Guest 7 Email
Guest 8
Guest 8 Email
Guest 9
Guest 9 Email
Guest 10
Guest 10 Email

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10. Are any of these guests wheelchair users?

Are any of these guests wheelchair users?   Yes No

11. If yes please state their names below

If yes please state their names below

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12. Do any guests have any special dietary requirements? (i.e vegetarian)

Do any guests have any special dietary requirements? (i.e vegetarian)   Yes No

13. If yes please state their names below and individual requirements

If yes please state their names below and individual requirements

14. If you know of someone who has purchased a ticket and you would like to be on their table please specify their names below:

If you know of someone who has purchased a ticket and you would like to be on their table please specify their names below:

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15. What prompted you to buy your Ball ticket this year?

What prompted you to buy your Ball ticket this year?   Bytesize Advert in Update Email notification Heard about it on my course Through a friend Other

Other (please specify)

16. The Back-Up Trust will use your email for the sole purpose of correspondence for The Back-Up 1950's Rock N Roll Ball 2010. If you do not wish to receive future correspondence from us please tick the box below.

The Back-Up Trust will use your email for the sole purpose of correspondence for The Back-Up 1950's Rock N Roll Ball 2010. If you do not wish to receive future correspondence from us please tick the box below.   Please tick here if you do not wish to receive any further information