EY Booking Form Template

Speech & Language Therapy, Training & Consultancy Services Gemma Kayum BSc (Hons) MASLTIP – MRCSLT - MHPC

COURSE BOOKING FORM Please complete this form and return it with payment to: TalkOut, 49 Victoria Grove, Shepton Mallet, Somerset

First Name Surname

Address Postcode Email Address (correspondence mainly via email) Telephone no.

Special Requirements

Organisation

Job Title NUMBER OF NAME/S OF COURSE REQUIRED PLACES DELIGATE/S JOB TITLE DELIGATE/S REQUIRED Sound Foundations (fee £27) Thurs 21st June

Tuning Into Communication (fee £27) Thurs 28th June Treasure Baskets & Heuristic Play (fee £27) Thursday 27th September Essential Communication (fee £32) Thursday 4th October

Total fee (payable to £ ‘Gemma Kayum’)

Booking To book, complete the booking form attached. Send a hard copy in the post with payment. Please make cheques payable to ‘Gemma Kayum’. Also, please return your form to this email address as an attachment (this will provisionally book you a place and help ensure a sucessful booking process). Any queries, please either email [email protected] or ring 0752 132 3639. Places are limited and will be allocated on a first come, first served basis. Location Shepton Mallet Leisure Centre, 11 Charlton Road, Shepton Mallet, Somerset, BA4 5PG The centre is on the main A361 road through Shepton and there is free parking. http://maps.google.co.uk/maps?q=ba4+5pg+map&hl=en&hnear=Shepton+Mallet+BA4+5PG, +United+Kingdom&gl=uk&t=m&z=16 Assurance I am fully qualified and registered Speech and Language Therapist. I am registered with 3 nationally recognised bodies, The Royal College of Speech and Language Therapists (ASLTIP), The Health Professions Council (HPC) and the Association of Speech and Language Therapists in Independent Practice (ASLTIP). My details can be found on all of their websites. These bodies audit quality and professional development and offer complaints procedures, should any client wish to file a complaint.

Terms and Conditions TalkOut cannot refund your course fee if you cancel your booking less than three weeks in advance of your course. The course fee includes refreshments (no lunch included). In the event that a course has to be cancelled due to unforeseen circumstances, a full refund will be offered or an alternative course date. Places are limited and will be allocated on a ‘first come, first served’ basis. Return this form by email for a provisional booking – places will be confirmed on receipt of payment. TalkOut is not liable for any course expenses such as travel.