32nd Annual Conference Patient Support Group Form Name of person completing this form(Required) Email of person completing this form(Required) Name of Patient Support Group (as you would like it to appear on company profile)(Required) Patient Support Group profile(Required)Max. file size: 15 MB.Patient Support Group logo(Required)Max. file size: 15 MB.Patient Support Group EmailAs you would like it to appear in your company profile. Please leave blank if you do not want this information included. Patient Support Group TelephoneAs you would like it to appear in your company profile. Please leave blank if you do not want this information included. Patient Support Group WebsiteAs you would like it to appear in your company profile. Please leave blank if you do not want this information included. Indicate the patient support group name as you would like it to appear on your name badges(Required)Patient support group badges are NOT personalised: they are inscribed with the name of the organisation only and are therefore transferable should you plan a changeover of staff during the event Dietary requirements for stand personnel Will the stand personnel be attending the Dinner on Wednesday 21 September(Required) Yes No Additional dinner ticketsPlease enter a number from 1 to 10.We provide 2 dinner tickets per stand . If you require additional tickets, please indicate here. Please note, additional charges may apply depending on numbers.