Course booking form

• First name
• Surname
• House number / name
• Street
• Borough
• Town / City
• Postcode
• Mobile or daytime phone
• Email address
• Reconfirm email address
• Details of access needs, if any (e.g. Do you use a wheelchair, walking sticks or require a BSL signer?)

Monitoring Information

PACE's courses are free to gay men in London, but in order to make sure our programme is targeting the right group of men, we need to know how many men of which age and which ethnicity attended our courses. We also like to know where you found out about this course, so we know where is the best place for us to promote it to future participants.

• Ethnicity White - British White - Irish White - Welsh White - Other Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Other Asian / Asian British - Indian Asian / Asian British - Pakistani Asian / Asian British - Bangladeshi Asian / Asian British - Other Black / Black British - African Black / Black British - Caribbean Black / Black British - Other Chinese Any other ethnic group
• If other, please specify
• Date of birth 12345678910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 1995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• Gender Male Trans
• How did you hear about this course? Advert in GT Advert in Attitude Advert in Boyz Advert in QX Advert in Pink Paper Advert in Bent Advert in Exposed Listings Advert in Fyne Times Advert in G Scene Advert in Out North East Advert in 3Sixty Advert or article in FS Advert in gay press By mailout From a local agency From a friend PACE helpline PACE workshop PACE email update PACE other GMI counsellor GMI mentor GMI health trainer THT direct THT workshop THT other Antidote At a clinic Online - GMFA website Online - search engine From a poster, postcard or flyer From a banner ad on Gaydar From a banner ad on another site Other - none of the above
• I do not want to receive email updates from PACE.
• I do not want to receive text messages from PACE.

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