UK Stroke Assembly North Monday 4 June Tuesday 5 June 2018 Radisson Blu Hotel, Manchester Airport, M90 3RA

Transcription

1 Use this booking form if you have aphasia or communication difficulties. If you need help completing this form, contact us on UK Stroke Assembly North Monday 4 June Tuesday 5 June 2018 Radisson Blu Hotel, Manchester Airport, M90 3RA Information about you We will not share this information with anyone Full name For your badge Address Telephone numbers Home: Mobile: I have had a stroke Year of stroke: Date of birth:

2 Ethnic origin: I am a carer / friend / family member I am a volunteer Do you use a wheelchair or scooter? Do you have aphasia? Do you have any other disabilities? Details: Do you need any help at the event? Details: Do you need a special diet? Details:

3 Are you allergic to any foods? Details: Are you allergic to any medicines? Details: In an emergency what medical information should we pass on to a paramedic? Please use a separate page if there is a lot of information Name: Relationship to you: Phone number : Mobile: Who should we contact in an emergency? Name: Relationship to you: Phone number : Mobile:

4 Parking is available at the venue. Costs will be covered. Please indicate if you will be travelling by car. Yes I will be travelling by car I have not decided how I will be travelling to the event More information about parking will be sent to you in May 2 day ticket for stroke survivor / carer / friend / family 2 day overnight ticket if booked by 3 April 2 day overnight ticket if booked after 3 April each each 1 day ticket for Tuesday 5 June 1 day ticket if booked by 3 April 1 day ticket if booked after 3 April each each If you cannot afford to pay, please contact us, we may be able to help

5 It is cheaper for people affected by stroke to book before 4 April A 2 day residential ticket includes: Dinner on Monday night Accommodation on Monday night Breakfast and lunch on Tuesday Drinks available all day on Monday and Tuesday The hotel If you are sharing a bedroom, the other person must fill in their own booking form The rooms have a double bed with their own bathroom Standard rooms have a bath with a shower over

6 Fully accessible bedrooms have a wet room bathroom Please only ask for one if a standard room would not meet your needs Bedroom type Standard room (with shower over bath) I am sharing with We would like twin beds double bed Fully accessible room I am sharing with

7 Bedroom requirements I would like a room near (add person s name) They are my carer Friend / family member On a lower floor (bedrooms are on floors 4-9) Near a lift Is there anything else you need in your room?

8 Presentations and workshops There are presentations in the main room for everybody together At other times there are workshops in smaller rooms If a workshop is full we will move you to another one If you feel tired you don t have to go to the workshops Choose one workshop per session. Your choices will be printed on your badge The event is very busy You may get tired Please take time to rest There will be places where you can relax Or visit the exhibition

9 Optional workshop Monday Choose one workshop from the following: a) Who is your stroke hero? Find out about our Life After Stroke Awards b) Living with aphasia Learn how to communicate more effectively c) Speaking out about the Stroke Association Help the Stroke Association to raise its profile d) Free time Workshop 1 Tuesday Choose one workshop from the following: a) Making our resources more accessible Tell us what we can do to improve our publications b) Could you be a Stroke Ambassador? Meet a Stroke Ambassador. Find out about awareness, prevention and campaign roles.

10 c) Help shape what the Stroke Association thinks Tell us your views on issues that affect stroke survivors d) Free time to visit the exhibition Workshop 2 Tuesday Choose one workshop from the following: a) My Stroke Guide Learn about this free online resource which aims to help you through your stroke journey b) Supporting carers and family members Share coping techniques and find out about support available c) Knowing you are not alone Discover the benefits of shared experiences and what help is available d) Free time to visit the exhibition

11 Marketing Tell us what you hope to gain from attending the UK Stroke Assembly Have you been to a UK Stroke Assembly event before? Do you want to be sent s about UK Stroke Assembly events in the future? Are you a member of a stroke club or group? If so, which one? How did you hear about the UK Stroke Assembly? How to pay: Online at or Send us a cheque. Write your cheque to the Stroke Association and write your name and UKSA North on the back of the cheque or Phone to pay by card over the phone during office hours

12 Post your form to: Fiona Clark UK Stroke Assembly Life After Stroke Centre Church Lane Bromsgrove Worcestershire B61 8RA Or your form to: Contact us for help with booking or any questions What next? We will send you a confirmation We will send more information to you in May Images are taken from past UK Stroke Assembly events and NIHR Clinical Research Network: Stroke website and resource pack designed to engage with those with aphasia