Email Personal details Name * Job Title * Email * Phone * Mobile/cell Twitter LinkedIn Company Name * Country * Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Company Address * Correspondance address if different Work email (if different) Additional attendees Ticket type * General admission £149 + VAT Online recording £49 + VAT Add Affiliate membership for only £9.99 + VAT for first year (normally £99) Add Associate membership for only £65 + VAT for first year (normally £129) Add Member membership for only £75 + VAT for first year (normally £149) Add Fellow membership for only £99 + VAT for first year (normally £199) Network Student, Affiliate or Associate member £74 + VAT Network Member or Fellow £39 + VAT Sector Field of mentoring (tick all that apply) * Education Further/Higher Education Career Apprentice Youth Refugee Complex needs Workplace Enterprise/entrepreneur Executive Peer Reverse Other (please state): Other sector Involvement in mentoring * Mentor Manage a mentor scheme Administer a mentor scheme Mentee Want to become a mentor Train mentors Other: Other Agreement and payment Terms and Conditions * Conference T&C's: • Refunds are not able to be given unless the event is cancelled for some reason – if you can’t attend you are able to arrange for a substitute to attend. • No liability – subject to refunds for our cancellation as above and liability we can’t exclude by law, we accept absolutely no liability for any matter arising out of this event. • You must comply with all reasonable directions of us and/or the venue when attending the event. • You agree that we may take photographs and/or film you as part of the event and that we have all rights in relation to such photographs and film. • You are responsible for making your own way to the event and for paying all expense connected with attending the event (such as travel or accommodation). • Any contract for this event is between you and The Root Of It Ltd, but if you are paying by card it will be listed as TKC. • You give us permission to use your data for the purposes of administering the event, compiling an attendee list and diseminating related materials, such as training opportunities. Payment Invoice Card payment (we will email you a link to make payment) Please note - Invoices will be sent in your local currency, card payments are processed in GBP. Multi-buy discounts are applied automatically in the card shopping cart when you add multiple tickets.