Twitter About You First Name * Surname * Contact Number * Email Address * Organisation If applicable We will have the opportunity for both Live and Pre-Recorded sessions, please confirm which you are comfortable partaking? * Live Stream Only Pre-Record Only Both - Live Stream & Pre-Record Please confirm you have the correct qualifications and insurance by providing details below: * Please upload evidence of the qualifications and insurance certificate referenced above here: * evidence 2 evidence 3 evidence 4 evidence 5 If you have more than 5 downloads please email further documents to administration@activeessex.org Please enter your professional membership number - if applicable e.g. CIMSPA, REPs About Your Activity Please tell us the types of activities you would like to lead Activity 1 Activity 2 Activity 3 Please advise the audience each activity is aimed at Audience 1 Audience 2 Audience 3 All instructors must upload a taster video for quality assurance - please use one of the three methods below to send this to us: 1) Upload video Video upload here 2) Add a URL below URL 3) Send via email to administration@activeessex.org send video in email I will be sending via email If you have a preference for date and time of session uploads, please state details below: Are you happy for your video to be saved and remain on the Active Essex YouTube Channel Yes No Please tick if you would like your video to be removed from the Active Essex YouTube channel after 3 months If yes, please tick if you would like your video to be removed from the Active Essex YouTube channel after 3 months Data Protection Please tick to confirm you are happy to be contacted by Active Essex using the contact details provided in compliance with GDPR View our Privacy Policy here
