Medact CiviCRM

First Name

Last Name

Phone Number

What PNP/Medact group are you a part of?

What are your dietary requirements?

What are your access needs?

We want to know what you need in order to participate. The gathering will be wheelchair accessible. Other access needs might include things like childcare, a quiet space or a prayer space. We sadly cannot organise interpretation for this workshop.

Is there anything else you would like to share?

Would you like to join the Patients Not Passports mailing list?

Yes, please keep me up to date!

We may use other details you enter through this form to help us with organising future work, and letting you know about relevant opportunities e.g. events local to you!

For full details of what we do to keep your data safe, including when you register for an event, please see medact.org/privacy