Book

Name

Mobile Number

Email Address

*

Activity you would like to book onto

Venue

Start Date

Time

Do you need to borrow equipment to take part in this session?

Yes

No

Do you have any special requirements? If yes, please state

Where did you hear about the Get Back Into project?

Heart FM
Billboard Advert
Bus Shelter Advert
Newspaper
Village/Community Magazine
Poster
Flyer
Newsletter
Word of Mouth
Other