Forename: *


Surname: *


Postal address: *


Postcode: *


email: *


Telephone#: *


Date of birth: *


How would you describe your ethnicity?: *
Asian: British Asian: Indian Asian: Pakistani Asian: Bangladeshi Asian: Chinese Asian: Japanese Asian: Other Black: British Black: African Black: Carribean Black: American Black: Other White: British White: Irish White: European White: Other Mixed parentage Other

Please provide the name and contact number of someone close to you in case of emergency during the workshop. Name: *


Contact telephone#: *


Contact's relationship with you:
Brother Daughter Father Flat-mate Friend Guardian Mother Neighbour Partner Professional Sister Son Wife Other

If this is you first Loving Men workshop, how did you find out about Loving Men?":
ECC advertisement Friend Loving Men flyer Loving Men newsletter Loving Men website PACE Previous participant Therapist Word of mouth Other

I wish to apply for a Bursary (we will send you a separate form for this):

What are you hoping to get from participating in Loving Men X?:


Are there any health concerns, disability issues or needs (physical or psychological) that it would be helpful for us to be aware of, to help you get the most from the week?:


Given my health needs, disability issues or psychological needs, I am unlikely to be able to engage in rostered household chores (washing up, table setting, food preparation, etc):

Accommodation preference - please select (Full fee £485):
In Hall- full fee In a Laurieston tent- full fee In my own tent or camper van- £26 reduction

The week at Laurieston Hall is full-board, with vegetarian food. Do you have any special dietary needs?:
No wheat No dairy No wheat or dairy Vegan Nut or other allergies- not life-threatening Sugar-free / diabetic

Any other dietary requirements:


I confirm that I do not have any dietary requirements that are life-threatening if not met: *

Is there anything else you’d like to share with us before the workshop?:


Transport: How are you planning to get to Laurieston Hall?:
Public transport Driving Passenger- lift arranged Passenger- seeking lift

If "Driving", I can offer:
1 2 3 4

lifts to Laurieston from:


and:
1 2 3 4

lifts from Laurieston to:


If "Passenger- seeking lift", I need to travel from:


and return to:


Terms and Conditions
The Loving Men Team asks you to:
• be responsible for your own safety and exercise due care for yourself throughout the event
• be respectful towards others and of their personal boundaries
• take care of the venue and equipment, and respect the boundaries of the Laurieston Hall Community.

I hereby accept these terms and conditions: *