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Your contact details

First name

Surname

Membership number

Telephone number

Email address

Address line 1

Address line 2

Address line 3

Address line 4

Address line 5

Postcode

Sponsorship request

If you are a student, please select your dental school below, if you are a dentist, please fill out your hospital or practice and postcode details, otherwise please fill out your organisation details.

Please note we no longer sponsor sports teams or sporting events.

School name (if you're a student)

Hospital or practice name (if you work in a hospital or practice)

Hospital or practice postcode (if you work in a hospital or practice)

(Other) Organisation name

(Other) Organisation postcode

Event sponsorship request

Name of event

Type of event

Date and time of event

Venue of event

Audience

Students

Dentists

Other

Total number of delegates expected

Publication sponsorship request

Name of publication

Date of publication

Number being circulated

General sponsorship request

Name of society/committee

Purpose of society/committee

Number benefiting from funding

Opportunities arising for sponsor

Attendance at event with stand and literature

Attendance at event as speaker

Use of DDU logo on marketing

Use of DDU logo on publication

Are there any other sponsoring organisations? If so please list them here

Account details

Do you have an official bank account (or access to an official bank account) from which you can issue an invoice?

Yes

Any other comments?

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