Rural Conference booking form Survey

Thank you for booking your place on our 2011 Rural Conference. We hope its going to be an informative event and an opportunity for you to meet colleagues, share news and expertise.

This third Rural Minds conference will address the impact of recent and divergent policy changes within both England and Wales on people facing mental health problems living in rural areas as well as showcasing examples of good practice in service delivery.

The conference will run over 24 hours and will include keynote speakers from Mind and the third sector, together with workshops around rural policy and practice as well as practical wellbeing sessions. There will also be a marketplace with stalls from a range of Mind’s departments including Policy and Campaigns, Specialist Support and the Local Influencing Project.

Please provide the following details:

Please provide the following details: Name:
Name of Organisation (if applicable):

Is your organisation one of the following:

Is your organisation one of the following: Local Mind

Voluntary organisation

Public sector

Other (please specify)

Please tick the following statement(s) that applies to you:

Please tick the following statement(s) that applies to you: I am a paid worker in mental health services.

I am a voluntary worker in mental health services.

I have responsibility for planning and/or funding mental health services.

I have direct experience of mental health problems.

Other (please specify)

Do you have any dietary requirements:

Do you have any dietary requirements: Vegetarian

Vegan

Gluten Free

Nut Free

Other (please specify)

Please detail any accessibility requirments you may have:

The delegate fee depends on whether you are attending as an individual or on behalf of an organisation, and whether you require overnight accomodation.

If you are attending on behalf of an organisation your fee will also depend on the income of the organisation and whether it is a voluntary sector or a public sector organisation.

Please indicate which fee is applicable to you:

The delegate fee depends on whether you are attending as an individual or on behalf of an organisation, and whether you require overnight accomodation. If you are attending on behalf of an organisation your fee will also depend on the income of the organisation and whether it is a voluntary sector or a public sector organisation. Please indicate which fee is applicable to you: Over night rate for individuals NOT associated with an organisation (Fee £50)

Over night rate for voluntary organisations (including Local Minds) with an income under £149,999 (Fee £50)

Over night rate for voluntary organisations (including Local Minds) with an income between £150,000 to £499,999 (Fee £75)

Over night rate for voluntary organisations (including Local Minds) with an income over £500,000 (Fee £125)

Over night rate for public sector organisations (Fee £125)

Day rate for individuals NOT associated with an organisation (Fee £30 per day)

Day rate for voluntary organisations(including Local Minds) with all income brackets (Fee £30 per day)

Day rate for public sector organisations (Fee £35 per day)

Mind will be running a mini bus service from Darlington train station to the venue, would you be interested in using the mini bus service?

Mind will be running a mini bus service from Darlington train station to the venue, would you be interested in using the mini bus service? Yes

There will be travel bursaries available to help cover part, or the total, travel costs for people who would otherwise be unable to attend.

The bursaries are dependant on you either being an individual NOT associated with an organisation or your organisation's income being below £150K.

Please indicate below if you think you are eligible and are interested in receiving a bursary towards your travel costs.

Unfortunately there is a limited fund available, expressions of interest will be dealt with on a first come, first served basis.

Bursaries will be allocated on Friday 5 August 2011 therefore all expressions of interest (which is done via this booking form) need to be registered before then.

You will be contacted regards your request for a travel bursary.

There will be travel bursaries available to help cover part, or the total, travel costs for people who would otherwise be unable to attend. The bursaries are dependant on you either being an individual NOT associated with an organisation or your organisation's income being below £150K. Please indicate below if you think you are eligible and are interested in receiving a bursary towards your travel costs. Unfortunately there is a limited fund available, expressions of interest will be dealt with on a first come, first served basis. Bursaries will be allocated on Friday 5 August 2011 therefore all expressions of interest (which is done via this booking form) need to be registered before then. You will be contacted regards your request for a travel bursary. Yes

Please provide your contact details

Please provide your contact details Name:
Address 1:
Address 2:
City/Town:
Postal Code:
Email Address:
Phone Number:

Rural Conference booking formExit this survey

Rural Conference booking form
Exit this survey