Professional Member application form for those who are attending the LHM Open Day & Annual General Meeting 23rd March 2024

For our professional members who wish to come and make it to our annual open day and AGM on the 23rd March, please complete the application form below:

Open Day 2024 - Professional Member application form who are attending the LHM Open Day & Annual General Meeting 23rd March 2024 (2)

Please provide details of all people attending(Required)

Please separate names with commas.

Please let us know which hospital you work for(Required)

Please separate names with commas.

Please provide your address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Email(Required)

Phone contact number(Required)

Photo Permissions(Required)

Yes I agree to the LHM photo permission statement

No I don't agree

Little Hearts Matter may want to live broadcast or screen capture this event for publishing online, please indicate above your acceptance or not of their use by LHM in the future.

Please provide any special dietary requirements(Required)

Please provide any special access requirement i.e. wheelchair access(Required)

Accommodation is available at Yarnfield Park Training Centre. Please call Yarnfield direct on (01785) 762605 and quote "Little Hearts Matter". Accommodation is also available at hotels near Stone, these are The Holiday Inn and Travelodge Hotels which are at junction 14 and 15 of the M6 and not far from Yarnfield.

Holiday Inn https://www.guestreservations.com/holiday-inn-stoke-on-trent-m6-jct-15-newcastle-under-lyme/booking?msclkid=048a30d63cc2136e9a84554e3034269d Premier Inn https://www.premierinn.com/gb/en/hotels/england/staffordshire/stafford/stafford-m6-southbound.html