BSL HM Key Information Form

BSL History Makers
22 - 24 November 2019

Key Information Form

* Indicates required field

Name *

First

Last

Title (e.g. Mr, Mrs) *

Date of Birth (DD/MM/YY) *

Gender *

Male Female

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Mobile Phone Number *

Email *

Nationality *

Marital status *

Are you employed/studying/in ministry/other? *

Emergency Contact Name *

First

Last

Emergency Contact Number *

Any health/dietary requirements *

Name of Home Church *

How are you planning to travel to BSL HM?

Please select *

Train Car Air Other

*The nearest train station to The Pines is Pulborough.
There is free car parking on-site at The Pines for guests.
The nearest airport to The Pines is London Gatwick airport.

Please let us know if you have any questions about travel *

Please give details of a church or ministry leader who can provide a reference for you.

Name of referee *

First

Last

Position *

Email *

Phone Number *

Mobile Phone Number *

The total cost of BSL HM is £50 per person.
Payment is due on acceptance of your application to secure your place.

Use of personal data: We will only use this information to make a decision on your application, and to contact you, or your referees, with regard to BSL HM. We will not share your personal data outside of K180 and the BSL HM leadership team without your consent. See our Privacy Notice for more information.

Submit

BSL History Makers22 - 24 November 2019​​Key Information Form

How are you planning to travel to BSL HM?

Please give details of a church or ministry leader who can provide a reference for you.

BSL History Makers
22 - 24 November 2019

Key Information Form