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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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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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