Details of the member you wish to contact: First Name * Last Name * I am looking for a Dyslexia Guild member who can provide me with (please tick the appropriate box or boxes): Desired services Tuition or lessons An assessment report to see if I or another person has dyslexia or other conditions Study skills support I am an adult over 16 yrs, seeking help for (please tick the appropriate box or boxes): Persons needing help Myself For my child/children On behalf of a friend or work mate You can contact me by: My name is (First name and Surname) * Telephone number Email address * The Dyslexia Guild will not be involved in any contracts and/or services that will be provided to you. Do ask about the qualifications and experience of the tutor/assessor before entering into any agreements for tuition or assessment services. What code is in the image? * Enter the characters shown in the image.