South East Region

SOUTH EAST REGION

Thames Valley Network Workshop 2017 SPEAKERS & SPEAKING APPLICATION FORM Please use a separate form for each person

Name ……………………………………………………………………………………..

Email ……………………………………………………………………………………..

OR Postal address ……………………………………………………………………

…………………………………………………………… Post code:………………….

Telephone number ………………………………………………………………….....

The day, including lunch is free but MUST be booked in advance please. For catering purposes, please complete this section. I would like lunch. YES / NO (Please delete as appropriate) I have special dietry requirements: NO / YES (specify)………………….………

I certify that I belong to : (all applicants must be members of a U3A)

…………………………………………………………………………………………U3A

I am a Speaker Secretary YES / NO I am interested in improving my speaking skills YES / NO I am just interested YES / NO

Signed…………………………………………………… Date ………………………..

Please return completed forms to: [email protected] or Mrs Susie Berry OBE Lavender Cottage Telephone: 01844 281137 Box Tree Lane Postcombe Mobile: 07966 132738 OX9 7DY

Please enclose an s.a.e. for acknowledgement, if you have not given an email address.