Casino Night

Your Name *

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Company Name (if applicable)

Job Title

Phone Number *

Dietary Requirements

Address *

Address line 2

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I agree that Child Brain Injury Trust can record and store my personal data (we will need to gain your permission to record and store your details to allow us to process your booking, If you would like to be removed from our records after the event please get in touch with us on office@cbituk.org and we will process this request) * Yes
No

I give consent to be contacted by the Child Brain Injury Trust by: Email
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I would like to receive newsletters via email * Yes
No

I would like to receive invitations to events and activities * Yes
No