EU EAST - IN or OUT? : YES I wish to attend

TITLE

FIRST NAME

SURNAME

ADDRESS

POST CODE

EMAIL

CONTACT NUMBER

OCCUPATION

AGE

ETHNICITY [leave blank if you prefer]

ACCESS REQUIREMENTS

MY EU VOTE

I expect to vote in favour of STAYING IN the EU

I expect to vote in favour of LEAVING the EU

Are you active in any EU referendum campaign groups?

If yes, what is the campaign?

MY QUESTION

If selected to be an audience member, I would like to ask the panel the following question:-

I have read, understand and I agree with the terms and conditions.

If you know of other friends, family or colleagues who might wish to also apply, please forward the email invitation to them.

Lizzy Dickinson, BBC Yorkshire Events Manager - The Ruby Awards 2016mobile: 07703 257503 email: lizzy@e2events.co.uk