EmailMe Form - What do we know about loneliness?

What do we know about loneliness?

An opportunity to explore the evidence base for the causes and effects of loneliness

A two day conference to be held on 9th and 10th July 2012 at Merton College Oxford in the stunning new TS Eliot Theatre. The cost is £150 per head including all meals BUT EXCLUDING accommodation

Both conference registration and accommodation may be booked using this form and will be charged at £78 (including VAT) for an en suite room; £64 for a room with a shared bathroom. Accommodation must be reserved at the time of booking.

Name
Prefix First Last Suffix
Prefix = Title (Mr, Ms, Dr etc) and Suffix = qualifications and honours (e.g. PhD, MBE etc)
Organisation
Position or job title
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Telephone:
If outside the UK, please include country code
Email
Mobile phone
Please include country code if your cell phone does not have a UK number
Conference reservation
When booking your conference place, please indicate whether you would like to reserve a room, and let us know of any dietary or access requirements
The delegate rate is £150 including all meals.

Upon receipt of your reservation, you will receive provisional confirmation of your place, and an invoice. Please note that your place will not be finally confirmed until payment has been received. Payment may be made by BACS or by cheque payable to Age UK Oxfordshire (details of account and address will be supplied with your invoice)
Please indicate any dietary requirements
Please indicate any access or mobility requirements
Accommodation requirements
Please use the drop down menu to indicate your accommodation requirements for the night of 9th July.
Invoice address
If the address to which invoice should be sent is not the same as the one you have given us above, please provide correct address here
Data Protection
Age UK Oxfordshire Group and partner organisations may NOT contact me by email or SMS with details of any future event or activity of a similar nature

The Age UK Oxfordshire Group and its partner organisations would like to keep in touch with you to let you know about the vital work we do for older people, our products and services. By submitting your email, address and phone number(s), you are agreeing to being contacted in these ways by Age UK Oxfordshire, its group of companies and partner organisations. If you do NOT wish to receive such communications please check the box above
Sponsorship
We are grateful to the Calouste Gulbenkian Foundation, IndependentAge, Oxfordshire County Council and the Campaign to End Loneliness for their support
Conference Administration

If you have any queries please contact Elizabeth Mills on +44 (0)1865 724695 or email elizabeth@eminence-grise.co.uk

Conference reservation

Sponsorship

Conference Administration