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 Exeter ongoing group in Tedburn St Mary on

• 15 & 16 April 2010
• 30 June and 1st July 2010
• 6 & 7 September 2010
• 25 & 26 November 2010

( ) I would like to book for the BBLL:Bristol Beaconsfield, London Lewes ongoing group on

• 1 & 2 April 2010 Chelwood Village Hall, Chelwood, Bristol, BS39 4NP.
• 1 & 2 June 2010 Reading Room, St Mary's Church, Old Town, Beaconsfield, HP9 1ND
• 19 & 20 July 2010 London (venue to be confirmed)
• 2 & 3 September 2010 Lewes, Sussex

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 four modules

I would like to take advantage of

1. ( ) the early booking discount and will send a cheque by 1st March 2010 for £750

2. ( ) the staged payments, and will send four cheques for £200 each by the 1st March 2010

Please date these

• 25 March 2010
• 25 May 2010
• 25 June 2010
• And 25 August 2010 if you do BBLL group, 20 November 2010 if you do Exeter Group

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

I am paying for BBLL Group

I am paying for the Exeter Group

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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