Mindful Towns - Expression of interest

1. Your details: *

First name:	*
Last name:	*
Phone number:	*
Organisation/group:	*
Town/Parish:	*
Email address:	*

2. What training would you like to attend? *

7 December, 9am to 4.30pm - Mental Health First Aid Champion, Starston Room, South Norfolk and Broadland Councils, Horizon Business Centre, Peachman Way, Norwich, NR7 0WF. Booking deadline 26 November
31 January, 9.00am to 4.30pm - Mental Health First Aid Champion, Hethersett Memorial Playing Field Pavillion, Park Drive, Hethersett, Norfolk, NR9 3EN. Booking deadline 21 January
15 March. 9.00am to 4.30pm - Mental Health First Aid Champion, The Costeseey Centre, Longwater Lane, Costessey, NR8 5AH. Booking deadline 6 March

3. Please let us know of any accessibility requirements you have.

4. How we use your data
South Norfolk Council and Broadland District Council (the Councils) takes your privacy seriously and will only use your personal data in relation to the mindful towns and villages project. To access the free training, we ask that you commit to joining our Mindful Towns/Villages and District Networks. If you do not provide the relevant consents outlined below, we may reject your expression of interest for the training.

Training
The initial phase of the project is the training. We would like to use the details you provide us through our booking form in the following ways;
• We may contact you via email and phone to confirm and remind you of your booking
• We will refer your full name and email address to the training provider of the session you book onto (Norfolk and Suffolk Foundation Trust or Thriving Workplaces), for them to provide you with details of the training, certification and an evaluation survey post training
• We will contact you via email or telephone to ask you to confirm your completion of the training

If you consent to us using and sharing your details as detailed above, please tick below: *

I agree to the Councils sharing my personal details to the relevant training provider in order to book me on the training indicated on this form and the Councils contacting me by phone or email as detailed above

5. Mindful District Network
Once you have undertaken the training, we would like to add you to your local Mindful District Network. This includes contacting you via the email address provided on this form with details of events, training opportunities and resources related to mental health and the Mindful District Network. If you consent to us contacting you for this purpose, please tick the box below:

You can remove your consent at any point. You can inform us in writing that you wish to be removed from the networks and your data will be removed from our records by emailing communities@southnorfolkandbroadland.gov.uk.

For more information on how to unsubscribe, our privacy practices, and how we are committed to protecting and respecting your privacy, please review our Full Privacy Notice within the Data Protection pages on our website. *

Upon completion of the training, I consent to being added to the Mindful District Network and receiving communications via email as detailed above.

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