Membership number

Question Title

* 1. Membership number

Regional Officer

Question Title

* 2. Regional Officer

Course title

Question Title

* 3. Course title

Course date

Question Title

* 4. Course date

Course venue

Question Title

* 5. Course venue

Course code

Question Title

* 7. Course code

Title

Question Title

* 8. Title

First name(s)

Question Title

* 9. First name(s)

Last name

Question Title

* 10. Last name

Date of birth

Question Title

* 11. Date of birth

Home address line 1

Question Title

* 12. Home address line 1

Town

Question Title

* 13. Town

Postcode

Question Title

* 14. Postcode

Telephone number

Question Title

* 15. Telephone number

Mobile number

Question Title

* 16. Mobile number

Email address

Question Title

* 17. Email address

Employer name

Question Title

* 18. Employer name

Employer address

Question Title

* 19. Employer address

Employer address line 2

Question Title

* 20. Employer address line 2

Employer town

Question Title

* 21. Employer town

Employer county

Question Title

* 22. Employer county

Employer post code

Question Title

* 23. Employer post code

Please indicate any disability and/or special needs that we may need to accomodate (eg dyslexia, hearing, impaired sight, mobility, dietary requirements etc)

Question Title

* 24. Please indicate any disability and/or special needs that we may need to accomodate (eg dyslexia, hearing, impaired sight, mobility, dietary requirements etc)

Ethnic origin

Question Title

* 25. Ethnic origin

Any other ethnic origin, please state

Question Title

* 26. Any other ethnic origin, please state

What trade union courses have you attended in the last three years?

Question Title

* 27. What trade union courses have you attended in the last three years?

Will your employer grant you paid release to attend a union course? If no, please see information at the bottom of the page*

Question Title

* 28. Will your employer grant you paid release to attend a union course? If no, please see information at the bottom of the page*

Are you a registered workplace rep?

Question Title

* 29. Are you a registered workplace rep?

Are you a registered safety rep?

Question Title

* 30. Are you a registered safety rep?

Are you a pensions rep?

Question Title

* 31. Are you a pensions rep?

Are you a learning rep?

Question Title

* 32. Are you a learning rep?

IT'S EXTREMELY IMPORTANT THAT YOU READ THE INFORMATION GIVEN BELOW

Once we have received your application form we will confirm in writing whether or not you have been allocated a course place. It is up to you to secure your paid release. Employment legislation entitles you to payment of wages etc for training you undertake that is connected with your trade union duties' (negotiating, representing people etc.) However, if you have been told by your employer that you won't receive paid release, you must raise the issue with your regional officer before you attend the course.

The education department is not responsible for obtaining your paid release. Course bookings will be made on a 'first-come – first-served basis.'

Question Title

* 33. IT'S EXTREMELY IMPORTANT THAT YOU READ THE INFORMATION GIVEN BELOW

Once we have received your application form we will confirm in writing whether or not you have been allocated a course place. It is up to you to secure your paid release. Employment legislation entitles you to payment of wages etc for training you undertake that is connected with your trade union duties' (negotiating, representing people etc.) However, if you have been told by your employer that you won't receive paid release, you must raise the issue with your regional officer before you attend the course.

The education department is not responsible for obtaining your paid release. Course bookings will be made on a 'first-come – first-served basis.'

T