Booking form: The EmptyStudio Weekend Courses 2016

PLEASE WRITE IN BLOCK CAPITALS Date of course: Name Email

Address Telephone: home/work/mobile:

Professional qualifications and membership number

Personal Therapy (duration and approach)

Basic Accommodation(see attached sheet for details)(please tick): Hired tent£10;Own tent£8; Summer-house £10; Conservatory£12;Outhouse(caravan-like)£12;(Rooms are sharedunless otherwise advised. If advised please add £3.00). Total: £

Fee/deposit: £280.00 / £80.00 plus any Empty SpaceAccommodation Cost  £

I enclose a cheque for the sum of £ (made payable to Professor Helen Payne)

I made a bank transfer and enclose evidence of the figure transferred If foreign currencyadd £7.00 commission fee

Please make cheques payable to Helen Payne or bank transfer details in GBP (not Euros please) Royal Bank of Scotland, St Albans branch, sort 16 3024 account 10024418 BIC RBOS GB 2L IBAN GB88 RBOS 1630 2410 0244 18

PLEASE NOTE: THERE ARE A MAXIMUM NUMBER OF PLACES AND THESE WILL BE ALLOCATED ON A FIRST COME FIRST SERVED BASIS. A WAITING LIST WILL BE KEPT IN THE EVENT OF A CANCELLATION. NO ACKNOWLEDGEMENT WILL BE SENT UNLESS REQUESTED WITH AN SAE.

I am applying for a place on the Authentic Movement course and have enclosed cheque/ transferred a non-returnable deposit of 80GBP plus the full cost of any Empty Space Accommodation to Professor Helen Payne. The balance on fees (200gbp, unless a discounted place confirmed) I understand is payable on arrival.

Signed………………………………………………….……………Date……………………………………………………………………

Return completed form directly to or post to Helen Payne, THE EMPTY STUDIO, THE POPLARS, REDHILL, RUSHDEN, HERTS SG9 0TH UKCLOSING DATE: Three weeks prior to commencement of course.Payment needs to be made at least 3 weeks before the course date or your place will be re-allocated. A refund, less £40.00 administration fee and catering, will be made if cancellations are received, in writing, at least 2 weeks before the course. We regret that any cancellation after this cannot be refunded, and that refunds for failure to attend the course cannot be made, but substitute delegates are welcome at any time. The full, fee less £10 administration fee, will be returned in the unlikely event that you are assessed as unsuitable for the course at this time. The organisers reserve the right to cancel courses that have not recruited to a minimum number by 3 weeks prior to the course date, whereupon named delegates will be notified and either an alternative course offered or a full refund made.