* 1. Membership number

* 2. Regional Officer

* 3. Course title

* 4. Course date

* 5. Course venue

* 7. Course code

* 8. Title

* 9. First name(s)

* 10. Last name

* 11. Date of birth

* 12. Home address line 1

* 13. Town

* 14. Postcode

* 15. Telephone number

* 16. Mobile number

* 17. Email address

* 18. Employer name

* 19. Employer address

* 20. Employer address line 2

* 21. Employer town

* 22. Employer county

* 23. Employer post code

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

* 25. Ethnic origin

* 26. Any other ethnic origin, please state

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

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

* 29. Are you a registered workplace rep?

* 30. Are you a registered safety rep?

* 31. Are you a pensions rep?

* 32. Are you a learning rep?

* 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.'

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