The Big Speak Out 2019 Booking Form

The URC Youth Logo

Booking form for participants
Age: 11 to 18 years inclusive

Welcome to the Big Speak Out registration page. Please fill in all the fields before 10 June 2019.

Attendee Details

First name(s): (*)
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Surname:(*)
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Known as (for name badge):(*)
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Gender:(*)
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Address
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Postcode:(*)
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Telephone number:(*)
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Email:(*)
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Date of birth:(*)
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Age (on 5/7/19):(*)
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Church name (if applicable):
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URC Synod (or Denomination/Group):(*)
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Member of Pilots:(*)
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Name of company (if applicable):
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Next of kin – emergency contact during event
First name(s):(*)
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Surname:(*)
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Relationship:(*)
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Email address:(*)
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Telephone number:(*)
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Mobile number:(*)
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Travel
How will you be travelling to The Big Speak Out?(*)
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Other form of travel:
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Anticipated time of arrival:
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Special requirements
Do you have any special dietary requirements (including vegetarian/vegan, allergies, intolerances, etc.)?
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Do you have a disability?
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If so, please tell us more:
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Is there anything we can do to help or support you?
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Costs
If money is an issue, please contact us on 020 7916 8637 or e-mail children.youth@urc.org.uk as financial support is available.

The cost of attending The Big Speak Out 2019 is:
Early bird bookings before 5pm Friday 26 April £69
Bookings after 5pm Friday 26 April £85

Please tell us how your costs will be paid: *complete as appropriate
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Cheque amount: £
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Please invoice:
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Ethnic diversity
The Big Speak Out 2019 is a safe and welcoming place for all, whatever your background or wherever you come from. Please help us to make this happen by telling us about your ethnicity.
I am:
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White Other:
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Black Other:
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Other (please specify):
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If you or your group need a leader to accompany you, please get in touch directly with the Children's and Youth Office on 020 7916 8683 or children.youth@urc.org.uk

The Children's and Youth Office data privacy notice can be found here.