Back BOOKING FORM E-LEARNING BOOKING FORM – Independent Living: A Complete Guide to Managing your Home Energy THE INDEPENDENT LIVING COURSE IS AIMED AT TENANTS LIVING IN ENGLAND AND WALES, AS WELL AS FOR FRONTLINE WORKERS WHO SUPPORT CLIENTS MOVING INTO INDEPENDENT LIVING. 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*Enter N/A if you are not part of an 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 TelephoneRegion (in which nation/ region is your organisation based – this should be your local office)*(PLEASE SELECT)England – North EastEngland – North WestEngland – Yorkshire / HumbersideEngland – East MidlandsEngland – West MidlandsEngland – EasternEngland – LondonEngland – South EastEngland – 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 Are these learners clients/ tenants who are moving into independent living or staff that support clients as part of their role?* Clients/ tenants Staff ReferralIf you are a client/ tenant, did you find out about this course through another agency? If so, please provide the name below to help us with reporting.4) FEE RATEFee Rate – please select* NEA MEMBER – Not for profit – £65 + VAT NEA MEMBER – Commercial – £80 + VAT Non Member – Not for profit – £75 + VAT Non Member – Commercial – £90 + VAT Funding for this subject ended on 31 March 2026, there aren’t currently any funded places available.5) INVOICE DETAILSThe 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.Organisation name*Postal address and postcode*Contact person*Contact email*Purchase order number (if required)*If a purchase order number is not required, please enter ‘N/A’ below.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: ~ cancellations received after login details are sent will still be charged at the full rate as outlined above. ~ 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 PROTECTIONWe collect and use your personal information to manage your booking and provide the services you’ve requested. To help us deliver the best possible support, we may share your information within our organisation. Your data will be handled securely and only accessed by authorised staff. We will never share your details with external third parties unless required by law. By submitting this form, you agree to the use of your data in line with current data protection legislation. 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.
