Training Booking Form

OXFORD CENTRE FOR ENABLEMENT

Neuro-Physiotherapy Assessment and Management

6th November 2017

APPLICATION FORM

Please use block capitals for name and address

Title: Mr, Mrs, Ms, Dr, Other / Surname: / First name:
Address:
Postcode:
Tel No: Work / Fax No: Work
Other / Other
Email address: / Profession:

I ENCLOSE A CHEQUE (made payable to Oxford University Hospitals NHS Trust) FOR

£95.00 q

Or: PLEASE FORWARD INVOICE TO (If being invoiced to a Trust please enclose an official order with your completed application) q

Or: If you wish to pay by CREDIT / DEBIT CARD, please email the Course Coordinator who will give you the information you require to do this. q

Name:

Address:

Please complete and return to COURSE CO-ORDINATOR, OXFORD CENTRE FOR ENABLEMENT, OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST, WINDMILL ROAD, HEADINGTON, OXFORD OX3 7HE or EMAIL TO:

NB. Should this course be oversubscribed your cheque(s) will be returned.

CANCELLATION: Substitution of delegates may be made at anytime, without cost, by a request to the course leader. Cancellations must be received in writing. A refund of the course fee, less a processing charge of £25, will be made if you cancel your reservation FOUR weeks prior to the date of the course booked. We regret that no refunds can be given after this date. Full refunds will be given if the organisers cancel the course.

Once we receive your form we will email you to confirm your booking. If you do not receive an email, or have any other queries, please contact Course Coordinator on: Tel: 01865 227 879 or Email:

Data Protection

Details of all client bookings are maintained on a computer system in line with the Data Protection Act. These details will not be made available to any other organisations for any purposes.

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