BOOKING FORM FOR ONGOING GROUPS

Please email this form back as soon as possible to reserve your place as places are strictly limited. (it is fine to send your cheque/organise payment separately)...so we know who is booking. Thanks

Please put a x where indicated ( )

( ) I would like to book for the ongoing group in Bristol and Tedburn St Mary on

• 5 & 6 May 2011
• 27 & 28 June 2011
• 22 & 23 September 2011
• 22 & 23 or 24 & 25 November 2011

I understand that I will pay for all the modules, whether or not I can attend them I understand that the groups will only go ahead provided sufficient numbers book in (all monies will be refunded if the 8 day workshop is cancelled) I understand that I will have three structures (client sessions) over the 8 days

I would like to take advantage of

1. ( ) the early booking discount and will send a cheque by 1st March 2011 for £800

2. ( ) the staged payments, and will send four cheques for £220 each by the 1st March 2011

Please date these

• 1 March 2011
• 1 May 2011
• 1 July 2011
• 1 September 2011

3. ( ) I would like to pay by credit card and will telephone you (telephone 01291 638805)

4. ( ) I will call you to discuss a payment plan that works for me.

Please make the cheque out to Juliet Grayson.

Send to Juliet Grayson, Courtyard House, Moynes Court, Mathern, Monmouthshire NP16 6HZ

NAME

ADDRESS

TOTAL AMOUNT OF CHEQUE

EMAIL

PHONE NUMBER (DAY)

PHONE NUMBER (EVENING)

PHONE NUMBER (MOBILE PHONE)

I WOULD LIKE A CERTIFICATE OF ATTENDANCE FOR CONTINUOUS PROFESSIONAL DEVELOPMENT (CPD) Please tick if required.

PLEASE NOTE ANY SPECIAL NEEDS HERE

telephone 01291 638805 inter.action@virgin.net

http://www.interactiontraining.co.uk http://www.therapyandcounselling.co.uk

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