Address: (Please use tab keys for next line) Postcode Telephone No. Mobile phone no. E-mail address Male Female Please tick if you would be happy to receive information by post e-mail telephone text Areas of Interest How would you like to be involved? Education Early years Primary Secondary Helping with events Respond to surveys Take up training opportunities Take part in consultaions Contribute to service evaluations Local groups Transition to Secondary Transition to Adult Examples of Training opportunities Respite Early support programme Palliative Care Confidence Building Continuing Care Disability Awareness Health Care Service Evaluation Direct Payments Negotiation skills Short breaks Children's rights Transport Computer Skills Play and leisure SEN and inclusion Effective communication Therapies Occupational Speech and Language Physiotherapy Please indicate any other services you have an interest in or any other ways you feel you could participate. Ethnic group: White British Black British Irish Mixed Asian Other Black Other or print off a Membership Form and send it to CEPCVoice, c/o DIB, Pierce Street, Macclesfield, Cheshire SK11 6ER
Telephone No. Mobile phone no.
E-mail address Male Female Please tick if you would be happy to receive information by post e-mail telephone text
Transition to Secondary Transition to Adult
Occupational Speech and Language Physiotherapy
Ethnic group:
or print off a Membership Form and send it to CEPCVoice, c/o DIB, Pierce Street, Macclesfield, Cheshire SK11 6ER
