Please help us to gauge interest in the 3-day retreat at Wortley Hall 27th -30th November.

This will help to assess how many rooms we can fill as well as what financial support co-ops / individuals will need in order to create an inclusive event that is open to as many people in or around the network as possible.

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* 1. Name

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* 2. Email

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* 3. What coop are you in?
(Enter "none" if you're not in one)

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* 4. How many tickets would you / your coop like?

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* 5. Can you provide a gender (rough) breakdown?

  Number of people
Male
Female

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* 6. Please choose your rooming options

  Number of people
Single occupancy (£103 / night)
Sharing (£87 / night)

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* 7. Do you need any financial support to cover the accommodation costs? If so, how much?

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* 8. Do you need help with travel to and from the event? If so, provide details of where you live.

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* 9. Would you or your coop be able to offer some financial support to other attendees?

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* 10. Are there any other people you know who might be interested in attending or that might benefit from doing so?
(Please enter name and details so that we can contact them)

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* 11. Do you have any dietary requirements or allergies?

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* 12. Do you have any accessibility requirements?
(The venue has wheelchair access but it will help them to know in advance)

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* 13. Were you happy with the faciliation at last year's event?

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* 14. Would you be happy to contribute to facilitation this year?

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* 15. Is there anything else you'd like to add?

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