Social Media Event Booking Form

If you are human leave this blank:

First Name *

Surname *

Please note the events are only open to those over the age of 18:

Age Please Select 18 - 25 26 - 35 36 - 45 45 + *

We are running two events, one aimed at community groups and one at businesses. Which would you like to attend?

Event Type Please Select Community Groups Business *

Organisation

Community Group

Which venue do you want to attend? Please Select Ebbw Vale Merthyr *

Please provide one of the following forms of contact

Address

Town

Postcode

Telephone

Mobile

Email

In which language would you prefer to receive information?

Language Please Select English Welsh *

Special requirements: If you have any special dietary or access requirements please complete below:

Below is a list of activities. Please tick the activities which you have done before, whether for personal or work use. You may tick any number of boxes below.

clicking a Facebook 'Like' button

commenting on somebody else's blog post

editing an article on Wikipedia

embedding a video from YouTube (or Vimeo) on a website

posting a tweet to Twitter

posting an update or commenting on Facebook

posting photos or video to Facebook

publishing a blog post (e.g. on Blogger, Tumblr, WordPress, Posterous or other blogging service)

reading an article on Wikipedia

searching on Twitter

signing up for a Facebook account

signing up for a Twitter account

subscribing to a feed on Google Reader

uploading a video to YouTube (or Vimeo)

using Google Docs

Have you any positive experiences you would like to share from using social media?

* Required fields