(Please print your name clearly as you wish it to appear on the Certificate)

Name:

Office Tel:

Mobile:

Home Tel:

Address:

E-mail:

Profession:

Degrees/Qualifications:

Professional Accrediting Body:

Reg/Accreditation No:

When sending in your application please ensure that the full course fee(s) are enclosed. Your cheque should be made payable to Saunders Clinic.

Payment:

I have enclosed full payment of £:

We accept all major credit and debit cards if you wish to reserve a place over the telephone and cheques made payable to Saunders Clinic if you wish to book by post.

Organisations

If your course is being funded by your employer please provide Purchase Order or Letter of Authority on Company Letter Head. This must be enclosed and forwarded with your completed application form.

Cancellation and Refund Policy

Cancellations up to 6 weeks in advanced of the course will carry a £25.00 administration fee, cancellations from 6 to 4 weeks prior to the course will receive a 50% refund. Unfortunately all cancellations after 4 weeks prior to the course commencement date will not be refunded.

The Saunders Clinic reserves the right to alter or cancel courses.

I have read and agreed to the above conditions.

Signature of applicant:

Date:

Please note any incomplete forms, i.e. unsigned, undated or missing the fees will not be processed.

I have enclosed:

• Completed application
• Cheque made payable to Saunders Clinic
• Credit/Debit Card details
• Please send me a receipt

Post for the attention of:

Please tick courses that you wish to attend.

Cheque enclosed

Paying by card

*all courses are subject to VAT at 20%