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booking form

When you register with Action Cancer, you will receive a copy of our News Update and will be updated with all the latest news and events from Action Cancer.

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Name Of School:

Contact Details

Title:

Forename:

Surname:

Address:

Town:

Postcode:

Phone:

Please indicate which School Action Programmes you are interested in:

	Single 'School Action' session
	'School Action' Programme (The following sessions are offered as a 4 week programme but may also be delivered on an individual basis. Please indicate which sessions you require.)
	Introduction - Why keep yourself healthy?
	Smoking, Alcohol & Sexual Health
	Being Body Aware
	Healthy Eating & Exercise
	'Smoking Cessation' Programme

Note: ‘School Action’ sessions can be completely flexible, lasting between 30mins to 1 hour. Please indicate your preferred date, time and length of session.

Preferred Date:

Preferred Time:

Preferred Session Duration:

Intended Audience:

	Male
	Female
	Mixed

Action Cancer will contact you to confirm your booking on receipt of this form. We will try to accommodate preferred dates and times as far as possible.

Please call us on 028 9080 3344 if you have any queries.

Data Protection: Action Cancer will not pass your personal details on to any other 3rd party organisation or company, for mailing or promotional purposes.