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1. Complete form
2. Send payment
Step 1: Complete and submit the form on this page. You will receive an email as a record of what details you gave us.
Step 2: Send payment separately (by credit card or BACS transfer).
Required fields are marked with *
Please write down the name of the organisation as it should appear on the glass panel of your plaque.
This should be checked and agreed by all the relevant people in your organisation before you send the form in.
You will not receive a proof, so please ensure these details are correct.
* I confirm that the wording above is correct and should appear on the plaque. Note: Paul Hodgkiss Designs and SCHWL will not be held responsible where organisations do not supply the correct wording for their plaques.
Please insert your Healthy Working Lives adviser's details.
Please choose your plaque level.
Please select the number of plaques.
Each plaque costs £225.82 (VAT and delivery charge inclusive).
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