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20 November 2008
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Delegate details:
Title:
First name: *
Surname: *
Job title: *
Organisation: *
Sector: *
Please select
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Industry: *
Please select
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Number of Employees: *
Address: *
Telephone: *
Email: *
Line Manager:
Line Manager's Job Title:
Booking Contact Name:
Booking Contact Telephone:
Please detail in no more than 200 words why you believe you are suitable for and would benefit from attending this Programme:*
Please outline in no more than 100 words the leadership challenge you face which you would want to work on over the course of the Stonewall Leadership Programme. It should be relevant in some way to your sexual orientation *
I have emailed a one-page version of my CV to: *
Brent.Chamberlain@stonewall.org.uk
I have read the cancellation policy and agree with the terms and conditions and undertake to attend all parts of the programme: *
Please select the applicable rate: *
A: Diversity Champions: £750 + VAT
B: Participants £950 + VAT
Access and dietary requirements:
Payment Details
Please indicate how you wish to pay for the programme:
Please contact me as above to allow me to pay by card
Please invoice me
If you have indicated you wish to be invoiced we will invoice you at the address detailed above. If, however, the invoice address is different from above, please supply the correct address here:
If you will be providing us with a purchase order for the invoice, please tick this box:
If you know the purchase order number, please provide it here:
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Questions: contact Stonewall's Workplace team on 020 7593 1850