Booking Form
Please return your completed Booking Form in the enclosed pre-paid and addressed
envelope OR email your details to [email protected]
Name & Address:
Guests Name:
Telephone No:
Email Address:
Attending:
Attending:
Lunch 12pm – 1:00pm
Seminar 1:00pm – 5:30pm
RRS Discovery Tour 5:30pm – 6:30pm
Dinner 7pm – 9:30pm
Special Dietary Requirements:
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


(Please advise any allergies or preference for a
vegetarian meal)
Lunch 12pm – 1:00pm
Seminar 1:00pm – 5:30pm
RRS Discovery Tour 5:30pm – 6:30pm
Dinner 7pm – 9:30pm
Special Dietary Requirements:




(Please advise any allergies or preference for a
vegetarian meal)
So that we can ensure adequate power supplies are available on the day:
Will you be using Oxygen:
Yes/No
Guest using Oxygen:
Yes/No
Will you be using a Nebuliser:
Yes/No
Guest using a Nebuliser:
Yes/No
Any additional requirements:
Any additional requirements:
Places are limited so please book early to avoid disappointment
Alpha-1 UK Support would like to send you information about future events and campaign information. If you do
not wish to receive this information please tick this box

Alpha-1 UK Support Group, 50 Wenning Lane, Emerson Valley, Milton Keynes, MK4 2JF
www.alpha1.org.uk Email: [email protected]
Chairman/Trustee: John L Mugford, Secretary/Trustee: Karen North, Treasurer/Vice Chair/Trustee: Christine Torrance
Registered Charity England & Wales 1146330 : Scotland SC043177
Patron: Professor R.A. Stockley MD, D.Sc, F.R.C.P. / Professor W MacNee MBChB MD FRCP(G) FRCP(E)