Application for consent for an exhibition, demonstration or performance of Hypnotism

SSDC - Privacy Statement on Handling of Personal Information

Details of person by whom the exhibition, demonstration or performance is to be given (“the hypnotist”)

Title *
Forename *
Surname *
Telephone Number *
Mobile Number
Email Address
Address of Hypnotist *

Details of the last 3 performances by the Hypnotist

Name of Venue: *
Date
Show Calendar
Description of Act: *
Contact Number (venue):
Name of 2nd Venue: *
Date
Show Calendar
Description of Act: *
Contact Number (venue):
Name of 3rd Venue: *
Date
Show Calendar
Description of Act: *
Contact Number (venue):