Exit Carer Application - Carers Parliament 2018 The 6th Carers Parliament will be held on Wednesday 24th October. The event will be held at the Royal Botanic Gardens in Edinburgh. If you complete this form you will be applying for a place. This application process will be for one delegate from each of the 73 Scottish Parliamentary constituencies. Places will be awarded via a ballot which will be drawn by Carers Scotland on 6 August 2018. If you are successful in the ballot, you will receive an email informing you of this and a link to a full delegate registration form, where you can tell us more about yourself and any support you need to attend. If you are unsuccessful, you will receive an email informing you that you have been added to the waiting list. If a place becomes available for your constituency or region, we will contact you as soon as possible to let you know. For information, carers from each area of Scotland will be represented in a number of ways. The first is through this open application process. Places will also be awarded through a closed process to: A carer representative and their substitute from each of the integrated joint boards in Scotland. If you are a carer representative on a IJB please do not apply through this form, you will be contacted separately. Young carers recruited in a number of ways including through the young carer projects Black and minority ethnic carers and carers from equality groups to ensure representation. Please note: We provide expenses, including replacement care and accommodation where required to enable carers to attend the event. Question Title * 1. Applications to this event are only open to carers and former carers only. This means people who provide unpaid care to family members, other relatives, partners, friends and neighbours of any age affected by physical or mental illness, disability, frailty or substance misuse. I am a: Carer Former carer Question Title * 2. First name Question Title * 3. Surname Question Title * 4. Your address: Address 1 Address 2 Town County Post code Question Title * 5. Telephone or mobile number Question Title * 6. Email address: Question Title * 7. Scottish Parliamentary Constituency (Please choose from the list below. If not known, please leave blank and we will complete for you) Aberdeen Central Aberdeen Donside Aberdeen South and North Kincardine Aberdeenshire East Aberdeenshire West Airdrie and Shotts Almond Valley Angus North and Mearns Angus South Argyll and Bute Ayr Banffshire and Buchan coast Caithness, Sutherland and Ross Carrick, Cumnock and Doon Valley Clackmannanshire and Dunblane Clydebank and Milngavie Clydesdale Coatbridge and Chryston Cowdenbeath Cumbernauld and Kilsyth Cunninghame North Cunninghame South Dumbarton Dumfriesshire Dundee City East Dundee City West Dunfermline East Kilbride East Lothian Eastwood Edinburgh Central Edinburgh Eastern Edinburgh Northern and Leith Edinburgh Pentlands Edinburgh Southern Edinburgh Western Ettrick, Roxburgh and Berwickshire Falkirk East Falkirk West Galloway and West Dumfries Glasgow Anniesland Glasgow Cathcart Glasgow Kelvin Glasgow Maryhill and Springburn Glasgow Pollok Glasgow Provan Glasgow Shettleston Glasgow Southside Greenock and Inverclyde Hamilton, Larkhall and Stonehouse Inverness and Nairn Kilmarnock and Irvine Valley Kirkcaldy Linlithgow Mid Fife and Glenrothes Midlothian North and Musselburgh Midlothian South, Tweeddale and Lauderdale Moray Motherwell and Wishaw Na h-Eileanan an Iar North East Fife Orkney Islands Paisley Perthshire North Perthshire South and Kinross-shire Renfrewshire North and West Renfrewshire South Rutherglen Shetland Islands Skye, Lochaber and Badenoch Stirling Strathkelvin and Bearsden Uddingston and Bellshill Question Title * 8. How did you find out about the Carers Parliament? Tick all that apply. Carers Scotland Coalition of Carers in Scotland Crossroads Caring Scotland Minority Ethnic Carers Project (MECOPP) Carers Trust Scotland Scottish Young Carers Alliance Shared Care Scotland A local carers centre or service A condition specific organisation such as the Huntington's Disease Association, MS Society etc. Another voluntary organisation such as Age Scotland MSP constituency office Through social media e.g. Facebook or Twitter Word of mouth Other (please detail below) Thank you for completing this application. We will inform you as soon as possible if you are successful or if you have been allocated a place on the waiting list. Carers Scotland organise the Carers Parliament on behalf of the national carer organisations and funded by the Scottish Government. Carers Scotland is part of Carers UK. Carers UK is committed to protecting your personal information and being transparent about what we do with it, no matter how you interact with us. You can read our privacy statement on the Carers UK websiteThe data we collect in this form is held by Carers Scotland and used solely for the purposes of the Carers Parliament and we will only contact you in relation to the Carers Parliament event. Done