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Online Application - Pouch Information Day 2010

If you have an Internal Pouch, or are thinking about having one, this is a chance to meet others with similar experiences and get the answers to all those questions!

Please note the booking fee is £5, which includes a buffet lunch.

Title
*

First Name
*

Surname
*
Address
*
Address
Address
Address
Postcode
*
Country
*
Tel
*
Email
*
Age?

*

Special Requirements?
(e.g. diet)

Do you have a pouch or ileostomy? If so for how long?
*
How did you hear
about the weekend?
*
Can your details be retained for future Pouch events?
Yes No

Please complete the above form then click 'Proceed' to connect to the Secure Server (where you can enter you card details with complete confidence)

Refunds Policy:
All refunds are at the discretion of IA

 
     
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