This form allows members to book places for themselves and their family, for the NN Open Day 2008.
Non-members should contact Paul White to make a booking (info@nystagmusnet.org).

We accept payment using WorldPay.

Once 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) Representitive's Details

Please enter the details of the group representitive (delegate 1):

Representitive's Full Name: A value is required.Minimum number of characters not met.
Age: A value is required.Invalid format.This person must be 16 or over. To book a place for someone under the age of 16 who will not be accompanied by an adult, you should contact Paul White via email (info@nystagmusnet.org.The entered value is greater than the maximum allowed.
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.
Full Name
Age
Delegate 2 Invalid format. The entered value is less than the minimum required.The entered value is greater than the maximum allowed.A value is required.
Delegate 3 Invalid format. The entered value is less than the minimum required.The entered value is greater than the maximum allowed.A value is required.
Delegate 4 Invalid format. The entered value is less than the minimum required.The entered value is greater than the maximum allowed.A value is required.
Delegate 5 Invalid format.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.A value is required.
Delegate 6 Invalid format.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.A value is required.
Delegate 7 Invalid format.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.A value is required.
Delegate 8 Invalid format.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.A value is required.
Delegate 9 Invalid format.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.A value is required.
Delegate 10 Invalid format. The entered value is less than the minimum required.The entered value is greater than the maximum allowed.A value is required.

3) Further Information

If any of the delegates have any special dietary requirements, please detail them in the box below. (Please clearly state the person's full name with their requirements).

A number of rooms for 2 to 4 persons will be available at Jury’s Inn on Friday 4th and Saturday 5th July at the specially discounted rate of £50.00 per room. To book these rooms, telephone the Conference Desk at Jury’s Inn on 0115 901 6740 quoting Nystagmus Network.

Please indicate the nights you will be staying at Jury's Inn (if any):
    Our group are planning on staying at Jury's Inn on Friday 4th July
    Our group are planning on staying at Jury's Inn on Saturday 5th July

Please indicate if you wish to use the hotel parking facilities (£6.00 per day, £10.00 for 24hrs, £16.00 weekend, payable on the day).

Please reserve car parking space for cars.

 

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: 01636 627004     Email: info@nystagmusnet.org
Address: Nystagmus Network, 13 Tinsley Close, Claypole, Newark, Nottinghamshire, NG23 5BS
Registered Charity Number: 803440