Health & Social Care Workshop Booking

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Workshop*

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Title

Name*

First Name Last Name

Email*

Enter Email Confirm Email

Primary Job Category*

Secondary Job Category - Education*

Secondary Job Category - Sports*

Secondary Job Category - Community & Faith*

Secondary Job Category - Youth Work*

Secondary Job Category - Health/Social Care/Family Services*

Secondary Job Category - Public Services*

Secondary Job Category - University*

Secondary Job Category - Other*

Organisation*

URN / SEED (If you are not sure of your organisation's URN/SEED number, please leave this field blank)

Please add your organisation's unique reference number, e.g. School URN / Charity Number

Date of birth*

This is information is required so that we can provide you with a certificate.

Postcode*

Please enter the postcode of your organisation or place of work. This helps us gather data to demonstrate our regional impact

Outside UK?

Please skip if you are within the UK.

What is the education setting of the child/children you have contact with?*

Please select all that apply

What is your young person reach?*

How many young people do you aim to work with on the topic of gaming/gambling over the next 12 months?

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