Your contact details will be safely stored in accordance with GDPR

In order to operate at maximum efficiency and to make sure that we are serving you to the best of our ability we need to keep all our details up to date.
Thank you for the time and the care you will take filling in this form.

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* 1. What is the name of your home/venue?

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* 2. Please give the full contact details of your home/venue

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* 3. Every Lost Chord Session costs in the region of £200-£225 to put on. We therefore ask for a minimum contribution towards each session of between £65 outside London and the Home Counties and £75 within London and the Home Counties (Berkshire, Essex, Middlesex, Hertfordshire, Kent, Buckinghamshire, Surrey, Bedfordshire, Cambridgeshire, Hampshire, Oxfordshire, East Sussex and West Sussex). We also add the cost of ULEZ and congestion charge if your venue is situated in that zone.
If you are looking for a full day workshop we ask for a contribution of £250. 
If you are having more than one session a month each subsequent session costs a little more. Full details are given upon request.
Please confirm you are willing to make a contribution towards the cost of the session.

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* 4. What is the name of the activities coordinator/primary contact?

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* 5. What is the email address of the activities coordinator/primary contact?

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* 6. Do you consent for Lost Chord UK to store your data in accordance with our GDPR  privacy policy available to read on our website? https://lost-chord.org.uk/privacy-policy/ 

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* 7. Please tick the days and times of the week that work best for you for a one hour Lost Chord interactive music session

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* 8. Do you have a piano we could use? We bring our own keyboard but if you have a piano we would love to use it!

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* 9. Is there parking at your home/venue?

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* 10. Are you interested in having a Lost Chord UK Choir/Singalong group?

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* 11. Are you interested in having a Lost Chord Bedside 1-2-1 iPad/Tablet session especially for those residents who live in bed and are not able to attend a Lost Chord session?

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* 12. Are you interested in having a Lost Chord UK full day workshop where we facilitate the writing of a song, lyrics and music? The day culminates in the residents/clients performing the song and we also incorporate an interactive concert into this special day.

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* 13. Do we need a Purchase Order Number to Invoice you? If you answer yes you will be required to send the PO numbers direct to LCUK once the session(s) have been agreed.

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* 14. Which email address do we send the invoice to? (This will come via Xero). Please note that we do not accept cash for sessions. If you pay by BACS bank transfer there is no surcharge.
If you pay by cheque there is a £5 surcharge and if you pay be stripe, go cardless or any other form of digital payment system there is a £2 surcharge.

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* 15. Which email address would you like us to send the booking confirmation document to? (This will come via Docusign.)

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* 16. What payment terms can you realistically make? For example if you make payments at the end of the month let us know or if you make two pay rounds a month etc
We have very strict payment terms which we have to adhere to in order to keep performing as many interactive music sessions as possible.

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* 17. Would you like Lost Chord UK to email you a poster about the concert to display in your home/venue? 

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* 18. Will you allow a Lost Chord UK Volunteer to accompany the musicians? They will follow the strict Lost Chord UK Covid protocols and are all enhanced DBS checked. 

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* 19. Lost Chord UK musicians will follow your protocols until they start performing then they will remove their masks, if you still require it and will socially distance for the remainder of the session. Is this acceptable

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* 20. Please enter any other information that you think is relevant

Thank you so much for taking the time to help us update our files so that we can work more efficiently and serve you better in the future.

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