Only use this form if you cannot open the Interactive Conference Application Form available here

Young people between the ages of 10 and 18 years of age may attend as delegates free

1) Personal information of the responsible adult filling in this form:

Name:

E-mail:

School/Org Telephone:

Position:

Mobile No:

Address:

City:

County:

Post Code:

Country:

LA Region:

LA PSHE Contact:

Name of school:

Address of school:

Name of Head:

Other relevant details:

Further Information:

2) You can nominate up to 3 young people who can attend as delegates on this form

• First Person
• First Name:
• Last Name:
• Age:
• Reason for nomination:
• Any Special Needs?:

• Second Person
• First Name:
• Last Name:
• Age:
• Reason for nomination:
• Any Special Needs?:

• Third Person
• First Name:
• Last Name:
• Age:
• Reason for nomination:
• Any Special Needs?:

Please note that this is a 2-day event. Priority will be given to those attending both days.

Please confirm which days you will be attending by ticking one of the 3 lines below:

We would like to attend both days (Monday and Tuesday)

We would only like to attend on Monday 20th Nov

We would only like to attend on Tuesday 21st Nov

Please state the name and position of the adult you will be sending to accompany the young people named above to the conference:

How will the young Delegates named above feedback to your school/organisation aboutthe conference?:

What anti-bullying strategies does your school or organisation currently have in place and does it include an anti-bullying policy?:

Would you like us to help arrange local B&B accommodation for you for the Monday night(20th)? There is a good range of 2,3 & 4 star available at very reasonable rates: Yes/No

This is going to be a fantastic uplifting, creative, innovative and energised event. Young people will beattending from all over the UK and abroad. We will be having a wide range of activities, presentations andresources on the subject bullying. It is a 2-day event. To help us keep the event running smoothly please ensure you have read and understand the 5 conditions below before signing and returning this form to us.:

1) It is your responsibility to make sure that the young people named above have parental permission to attend this conference and to be filmed or photographed by the young documentors as outlined below. By signing this form you are confirming that you have got all the relevant parental or guardian permissionsand/or consents required (this should be in the form of a signed letter from parents or guardians).Informed consent is important and it is your responsibility to ensure that the young people and theirparents are aware of this.

2) Please note that no movie or digital video cameras are allowed on site. You may bring in stills cameras.Please respect people's wishes if they asked not to be photographed.

3) Delegates and parts of the Conference may be filmed by the official young documentors. By signing thisform and sending it in to us you are giving permission for the people mentioned above to be filmed or have their photographs taken for future possible Conference or other promotions.

4) Please note that this is a FREE conference with free entry to all the festival activities on both days. A free lunch will also be provided on both days for all delegates and there will be free refreshments available during the day. You will need to pay for your own travel and accommodation costs. We can help book local accommodation for you if requested at very reasonable rates or can provide you with a list of local accommodation. There will also be a selection of family share houses for those on low budgets. We also have a limited amount of bursary payments we can make for those with exceptional financial difficulties. If you have any questions, concerns or queries please contact us to discuss them on 01934815163. Please note that priority will be given to delegates who are coming for both days.

5) Please do not book if you are not sure you can attend, as others will lose out who could have taken your places. Food and resources could also go to waste. This is a free event but if you book and do not turn up you will be liable to a £100 administration charge, which we will invoice you for. Please take this in to account when filling in this form. By signing this form you agree and accept liability to this condition. We don't want to charge you so please be sure that you want to attend and can attend before signing and returning the form to us. Thank you.

I confirm by signing this form that all the information contained in this form is true to the best of my belief & that I have parental permission for the young people named above.

Signed:

Name:

Position:

Date:

Name of Head Organisation:

Please state the total number of people you want to send including adults:

Please state if you will be making a voluntary donation to the conference and amount in pounds sterling. (Please make cheques payable to 'I Power I'):

Once we recieve your signed form, we will write back to you confirming your places along with a map and directions.

Registration starts from 9.30am on the 20th Nov. The Conference starts at 10.15am

Upon arrival all delegates will sign-in, sign up for their workshops and festival activities, receive a special conference pack, afull conference programme and other items.This event will be held at the Winter Gardens in Weston-Super-Mare, in the South West of England. Direct national rail link, 10 minutes to M5 motorway, 25 minutes to Bristol airport and 5 minutes to the seaside.

Post form & any donation to: Andy Hickson, Actionwork, Bully Conf, PO Box 433 Weston-Super-Mare, Somerset BS24 0WY England UK