Course Registration Form

Course Venue/Area (required)

Course Date (required)

Your Name (required)

Your Address (required)

Your Email (required)

Your Daytime Telephone (required)

Your Evening Telephone (required)

Your Profession (required)

Your Speciality e.g. MSK, Respiratory (required)

Your Dietary Requirements

Other Specific Requirements e.g. access

Where did you hear about the course e.g. website, leaflet, word-of-mouth etc

Message (include any additional information you wish to add)

Course fee: £210 per person. Fee inc. refreshments and course materials (excl. lunch)

 

Payment options

 

  • Send cheque payable to Dr Zara Hansen to: Zara Hansen, CBT Skills Training, 26 Ashton Drive, West Kirby, Wirral, CH48 0RQ

 

  • Pay by BACS using your name as the reference. Account name: Dr Zara Hansen; account number 01221846; sort code 30-13-55. Email or send through your registration form and mention that you are paying by BACS.

 

  • Direct invoicing of employer not available. Please request a receipt for payment if required.

 

Cancellation policy: full refund less admin fee of £10 if cancelling more than 2 weeks before; non–refundable within 2 weeks, unless your place is filled.

 

You will receive confirmation of your place upon receipt of the fee.

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