To book places for the 2011 Nystagmus Network Open Day in Harrow, north-west London, please complete the form below.

We accept payment using WorldPay.

The online booking facility for this event is now closed.

After completing the form you will be asked to confirm the details you have entered are correct, then you will be taken to WorldPay to complete the transaction.

1) Representative's Details

Please enter the details of the group representative (delegate 1 — must be 16 or over):

Representative's Full Name: A value is required.Minimum number of characters not met.
Member/non-member
Contact Telephone Number: A value is required.Minimum number of characters not met.
Contact Email Address: A value is required.Invalid format.

2) Details of Delegates

Please add the details of any other delegates in your group. To do this, simply type their full names into the appropriate boxes below. When you enter a delegate's name, a box will appear next to it to enter their age. Note that children are free up to the age of 7. The crèche is now full, but children above the age of 8 are welcome to take part in the LOOK DVD making activity.
Full Name
Age
 Member/non-member
Delegate 2
Delegate 3
Delegate 4
Delegate 5
Delegate 6
Delegate 7
Delegate 8
Delegate 9
Delegate 10

3) Further Information

If you would like to take part in the LOOK activities for young people (8-25) or have any special dietary or other requests, please give details below or contact John Sanders by phone on 029 2045 4242 or 0845 634 2630 or email john.sanders@nystagmusnet.org

Where did you hear about the NN Open Day 2011?

4) Proceed

Please click the button below to confirm the details you have entered are correct. If clicking the button does not take you to a new page, then you need to ensure you have filled in all the required fields correctly (see fields with red backgrounds).

Contact Details: Tel: 0845 634 2630 or 029 2045 4242
Email: john.sanders@nystagmusnet.org
Registered Charity Number: 803440