Professional Development Workshops
Application Form

Please print this form out and post it in to us.

Please reserve me a place on the following workshop(s)

Workshop Title:__________________________________ Date:________________________

Workshop Title:__________________________________ Date:________________________

Workshop Title:__________________________________ Date:________________________

Workshop Title:__________________________________ Date:________________________

Name:____________________________ Email Address:_____________________________

Postal Address: ______________________________________________________________

___________________________________________________________________________

Postcode:____________________________

Telephone No:________________________Home
Telephone No:________________________ Work
Telephone No:________________________ Mobile

Occupation:____________________________ Theoretical Model: ______________________

I am/am not a member of the Directory of Pink Therapists (please delete as applicable)

We are able to accept payment by Credit/Debit Cards and cheques.  Cheques should be made payable to Pink Therapy.

Please debit my Credit/Debit Card the sum of: £
(please fill in the total cost to be debited)
We can accept: Mastercard    Visa   Visa Electron    Maestro   Switch   Solo  (please circle relevant card)

Valid From:                                                                  

Expires:                                               

Switch Issue No:

CVP: Security Code [these are the last three digits on the back of your card on the signature strip:

Please ensure you give the card holders address if this is different from the address you have given on the application form:

Signed: _____________________________ Today's Date: ____________________________

I enclose a payment to: Pink Therapy for £105 per workshop (if you are a member of the Directory of Pink Therapists or £115 if you a non-member. If you are booking for 3 or more workshops then you may deduct £10 for each workshop you are booking. The Psychosexual Course is £230 for the two days (or £210 for Directory Members)

Signed: _____________________________ Today's Date: ____________________________

Please post this form, along with your fee to:

Dominic Davies
Pink Therapy
Flat 3
3-4 Archer Street
London
W1D 7AP

Terms and Conditions
Fees: The full fee for each workshop is £105 per day for members of the Directory of Pink Therapists or £115 for everyone else. or £210/£230 for weekend training. Cheques should be made payable to Pink Therapy in GB sterling. Payment must accompany all orders, and we are not able to invoice you.
Receipts: A receipt will be sent along with your booking confirmation and details of the venue.
Cancellations: There is an adminsitrative charge of £15.00 per person for cancellations received in writing up to one month prior to this event. Thereafter no refund is possible.
Indemnity: This booking constitutes a legally binding contract. It may be necessary, for reasons beyond the control of PInk Therapy to change the programme, speaker, date or venue. In the unlikely event of a programme being cancelled, a full refund will be made, but Pink Therapy disclaims any further liability.
To change a delegate, please call at least seven days prior to the event.

Pink Therapy reserves the right to amend, change or cancel workshops or trainers at its own discretion due to circumstances beyond our control.