Pouch Information Day Booking Form

Ileoanal pouch or Kock pouch

This is a joint event for people interested in presentations and discussion on either Ileoanal pouch or Kock pouch. If you wish to attend this event, please complete the form below specifying which of the events you are attending or contact IA National Office on either freephone 0800 018 4724 or 01702 549859.

Pouch Information Day – Newcastle
Saturday 28 September 2019 – 10:30 until 16:00 (start and finish times approx.)
Jury’s Inn, Scotswood Road, Newcastle NE1 4AD
Cost: £6 non-refundable to include buffet lunch and refreshments

Booking is essential
A separate booking is required for each delegate.

Event Details

Please select which event you are booking:

Card Holder Details

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Full Name
Address
Town / City
Postcode
Country
Email

Attendee Details

Check this box if the card holder is also the attendee
Title
Full Name
Address
Town / City
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Email
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Age Group
Do you have any special dietary requirements?
Are you an existing IA member? If so, please select your local group
How did you hear about this event?
Would you like to hear about future Pouch Group events?
YesNo
Any other information

Refunds Policy

All refunds are at the discretion of IA.

Gift Aid

If you are a UK taxpayer a charity can claim a tax repayment amount in line with the tax rates current at the time of the payment, at no extra cost to you. By selecting 'Yes' above, you are confirming that you wish the Charity to claim Gift Aid on this payment and all payments that you make from the date of this declaration, and you are confirming that you have paid UK Income Tax and/or Capital Gains Tax at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs) that you donate to will reclaim on your behalf and that you understand other taxes such as VAT and Council Tax do not qualify.