Essential Companion Organisation Application Organisation Name Contact Name Are you a CharityLocal/Heath AuthorityPrivate Company Carer Requirements 1:11:21:4Other Other (please specify) First line of organisation address Postcode Email Telephone Which of the following preferences would you like us to assist you with in future bookings? Aisle Seat Wheelchair Space Large Wheelchair Space Stalls Seat Induction Loop Please provide as much information as possible as to why members of your group require an Essential Companion: Please tick to confirm you have read the terms and conditions of becoming an Essential Companion (required)