BOOKING FORM Introduction to Domestic Energy Efficiency E-Learning StepChange E-LEARNING BOOKING FORM – Introduction to Domestic Energy Efficiency TO BOOK A PLACE ON THIS E-LEARNING MODULE, PLEASE COMPLETE THE FOLLOWING FIELDS. PLEASE NOTE: Once you complete the booking form and select submit you should see a confirmation note on screen. If not and instead you return back to the top of the booking form, your booking is not complete. Please check that all relevant fields are complete (all fields marked with a * are mandatory) and your e-mail address is correct then submit again. 1) PROPOSED START DATEDate*PLEASE NOTE – this course is self-led so there are no set dates to attend (this is just an indication of when you would like your learning to begin. It can take up to 5 working days for login details to be sent). DD slash MM slash YYYY 2) BOOKING CONTACTFirst name* Surname* Organisation* Organisation sector (please select the most relevant sector or select other)*(PLEASE SELECT)Advice agencyDistribution Network Operator / Gas Distribution NetworkEducationFuel UtilityGovernmentHealthHome Improvement AgencyHousing AssociationInstaller / ConstructionLocal AuthoritySmall Community GroupOtherN/AEmail* Enter Email Confirm Email Telephone*Region (in which nation/ region is your organisation based – this should be your local office)*PLEASE SELECTEngland – North EastEngland – North WestEngland – Yorkshire / HumbersideEngland – East MidlandsEngland – West MidlandsEngland – EasternEngland – South East / LondonEngland – South WestScotlandWales – NorthWales – South3) LEARNER DETAILSPlease list all learners*Click ‘+’ to add additional names. Location details are requested to help us monitor the reach of learning across the country. Personal details will not be shared with others. NameE-mailCountyPostcode What are the main services your organisation provides to households at risk/or in fuel poverty*4) FEES / FUNDED PLACEFee Rate – please select*As indicated in the course outline, funded places are available to non-commercial/ not for profit organisations in England and Wales (such as local authorities, housing associations, advice agencies etc). Learners must also be frontline staff or volunteers that encounter and provide advice to clients in or at risk of fuel poverty (essentially those on a low income/ in a vulnerable situation and who are struggling to manage their household energy needs). Standard fees for learners that do not meet the above criteria are outlined below. FUNDED PLACE – I work for a non-commercial organisation based in England or Wales AND encounter those in or at risk of fuel poverty. NEA MEMBER – Not for profit – £65 + VAT NEA MEMBER – Commercial – £80 + VAT Non Member – Not for profit – £75 + VAT Non Member – Commercial – £90 + VAT IMPORTANT NOTE: NEA relies on funding from external sources to enable us to offer free training activities. In order to fulfil our commitments to funders we need to ensure that learning takes place on time and that we meet the required minimum number of learners. Failure to do this may impact on future funding. If you receive a funded place and no longer wish to complete the course please inform NEA as soon as possible so that your place can be reallocated. 5) INVOICE DETAILS (if required)The details provided in this section will be used to issue an invoice. Please provide the relevant finance / accounts payable contact details and if needed, a purchase order number to ensure prompt payment. If you are applying for a funded place, you do not need to complete this section.Organisation name Postal address and postcode Contact person Contact email Purchase order number (if required) 6) TERMS & CONDITIONS Once in receipt of this completed booking form, NEA shall aim to provide the learner with login details to access the e-learning within 5 working days. The learner must not disclose their login details to others. The learner will have access to the course for four weeks. The e-learning is copyright protected and must not be printed or copied. Cancellations: ~ Non funded places – any cancellations received after login details are sent will still be charged at the full rate as outlined above. ~ Funded places – cancellation charges do not apply but if you are unable to complete the course please inform NEA as soon as possible so that your place can be reallocated. Please note that while the place is free of charge to the learner there is a cost implication to NEA to deliver the webinar and failure to inform us that you are unable to attend prevents us from being able to re-allocate the place and can have knock on implications to future funding. Regular cancellations or non-completion may result in future bookings being blocked. Notice of cancellation must be confirmed in an email. These conditions will not apply if the course is postponed or cancelled by NEA. AGREEMENT* I agree to the above terms and conditions of booking7) DATA PROTECTIONNational Energy Action collects personal information when you book on to a training event; this is used to provide the services requested; report to funders (if necessary); and to evaluate our services. We will not share your details with any other third parties without your consent. By submitting your booking form, you are agreeing to these terms. Our full privacy policy can be viewed at the following link – https://www.nea.org.uk/privacy-policy/ AGREEMENT* I agree to the above privacy policyMAILING LISTS*From time-to-time NEA may also send details of further projects / training events including free courses. Would you like to be included in these mailings? YES NO 8) CONFIRMATIONIf you have read and agreed to the above information please select the submit button below to complete your booking. PLEASE NOTE BEFORE SUBMITTING: If you return to the top of the course outline once you select submit, your booking is NOT complete and the form has not submitted properly. Please check that all relevant fields are complete (all fields marked with a * are mandatory) then submit again. Once submitted, a confirmation note should appear on screen and you should receive a confirmation e-mail.
