Irish UNESCO Geoparks Forum

Name*

First NameLast Name

Organisation*

Email*

example@example.com

I give consent to be contacted (by email) by Geopark staff to provide feedback following the event.

YesNo

Phone Number*

Emergency Contact*

Emergency Contact First NameEmergency Contact Last Name

Emergency Contact Phone Number*

Please state any medical condition(s) that staff may be required to know (if any conditions e.g. asthma. Please ensure all necessary medication is brought to the activity).

Do you have any dietary requirements?

YesNo

If yes, please specify.

I hereby give Irish UNESCO Geoparks forum the right to use photographs/recordings of me/my child/my children at the event. I understand that, if I allow, the image(s) may be used in Irish UNESCO Geopark forum member orgnisations communications, promotional material to include social media, the Council website, leaflets and printed publications and/or the media. We will not include names of any child with images used although we may add a general label to a group image. You have the right to request the image(s) is removed/deleted but please note, depending on if/where the image(s) is used, removal/deletion may not be achievable. Please contact the Geopark on +353 (0)71 9853692 for further information.*

YesNo

My Products

How many spaces would you like to reserve?Please select number.

$ Free Quantity

Total

$0.00

Will you attend the field trip?*

YesNo

The field trip will take place between 9.30am and 4:00pm on Friday 8 November and will include a boat tour on Lough Oughter, lunch at Tully Mill and a visit to Cavan Burren Park.

Will you stay overnight?*

YesNo

To Book your accommodation with a special conference rate (Dinner, B&B €180.00)

Call (049) 9526444 and click reservations or email Slieve.Reservations@slieverussell.ie and quote: Irish Geoparks Forum

Please check your inbox and junk for a booking receipt from noreply@jotform.com before attempting to submit the form a second time to avoid duplicate booking.