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During the week of the Party, if you need to phone me, I will be on 0705 0092125 John.

Your Name (s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . Telephone number . . . . . . . . .

I would like to come to the Party YES / NO (tick or ring which one you choose)

I require transport by a) Ambulance YES / NO - (do you have to stay in your wheelchair? YES / NO)

or b) by Car YES / NO - I really need a front seat YES / NO

 

or c) I will find my own transport YES / NO

If coming by car and you can only walk short distances without a wheelchair,

can we leave it at home and supply you with our wheelchair for transport at the Party? YES / NO

OR, I will be bringing my wheelchair YES / NO - can it fit in a car boot YES / NO

 

Any special dietary requirements? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Do you have a CONTACT visitor at present YES / NO if so what is their name? . . . . . . . . . . . . . . . .

When did they last visit you? . . . . . . . . . . . . . . Any other comments? . . . . . . . . .

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Please return this slip BY THE 31st MAY to

John Walker, CONTACT, 11-12 Trumpington Street, Cambridge CB2 1QA

( or you may phone on Cambridge 360441 most Mondays to Thursdays after 1.30 pm)

 

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