Exit this survey #RECT19 RECT 2019 Application Form Question Title * 1. Your ATL, NUT or NEU Membership Given Name Family Name Membership Number Question Title * 2. We will need to contact you to confirm details of the event please complete the details below. Home Address Personal Email Address Home Phone Mobile Phone Work Phone Question Title * 3. Where do you work? Name of establishment Name of Workplace Rep(s) Question Title * 4. Which Local Authority do you work in (if more than one, which one do you mainly work in)? Cumbria Darlington Durham Gateshead Hartlepool Middlesbrough Newcastle North Tyneside North Yorkshire Northumberland Redcar & Cleveland South Tyneside Stockton Sunderland York Question Title * 5. What phase do you work in? FS KS1 KS2 KS3 KS4 Question Title * 6. Are you? Classroom teacher Support Staff TLR Leadership group Question Title * 7. How many years have you been in this role? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Question Title * 8. RECT is a residential event and single accommodation will automatically be reserved for you on Friday and Saturday evening.If you wish to share a room with a friend or partner please give their name in the box below and state whether you require a double or twin room. We can accommodate more participants if friends share a room.Friends and partners who are not participants will need to pay for meals and any supplementary room charges. Question Title * 9. Do you have any dietary requirements (eg vegetarian)? If so, please specify. Question Title * 10. Do you have any access/accommodation requirements (eg mobility assistance or large print documents)? If so, please specify. Question Title * 11. Do you have any requests for Workshop Sessions (one request per line)? 1) 2) 3) Question Title * 12. Have you attended a RECT weekend before? Yes No Question Title * 13. RECT is free for members; however, there will be a £50 charge, as a contribution towards the cancellation fee, if you do not attend without providing adequate notice and reason for non-attendance.Do you accept these terms? Yes No Question Title * 14. FOR OFFICE USE ONLY Submit your application for #RECT19
