Register Interest

Please complete the form to register interest for each of the events. We will contact you via the supplied email regarding the event.

Name

First Name

Last Name

Address

Postcode

Phone

Are you able to use Zoom?

Yes

No - I need help with Zoom

Do you have access to a device? (e.g. Tablet, Smart Phone, Laptop)

Yes

Do you have disabilities or any particular requirements?

I agree for my photograph to be taken during the programme for use in Lagmore Community Association and Colin Neighbourhood Partnership’s social media platforms and community publications.

Agree

Don't Agree

I consent to the Holistic Mums Privacy Policy

I agree to join the Holistic Mums Whats App group to receive updates on the programme.

Yes