Complete This Form Using BLOCK CAPITALS and Return To

Complete this form using BLOCK CAPITALS and return to:

Training and Special Events Unit, Mind, 15-19 Broadway, London E15 4BQ

Please use a new form for each delegate.

Date on which you would like to attend:...... Location:......

Course name:......

How did you hear about the course?......

The fee charged depends on who is paying. Please tick the appropriate amount

Fees for Mental health awareness training

 £159–Concessionary rate (unwaged/ student)

 £189 – Local Minds rate

£199–Early bird booking (must be at least 2 weeks before course date)

 £229–Regular booking rate

Prices include the training session, your comprehensive training materials, lunch, coffee/tea on arrival, mid-morning and mid-afternoon.

Delegate details

Title...... First name...... Surname......

Job title...... Organisation ......

Address......

Postcode...... Tel......

Fax...... Email......

Dietary requirements ...... Access requirements......

(E.g. large print, hearing loop)

Payment methods (tick only one box)

 Cheque enclosed for £...... (payable to Mind)

 Charge my credit card:......

 Visa Mastercard Switch (we do not currently accept Amex)

Card number...... Expiry date......

Cardholder name...... 3 digit security code......

Signature...... Billing address (if different to above)......

...... Postcode......

Booking terms and conditions

Cancellations:Cancellations received in writing less than one month before the course date will be charged a 20% cancellation fee. Cancellations received after this time will be liable for the full registration fee. Substitutions can be made at any time without charge. In the event of circumstances beyond its control, Mind reserves the right to amend or cancel any training course. Mind is not liable for any expense incurred by delegates as a result of cancellation.

Joining instructionswill be sent out approximately two weeks before the course

Programme: All courses will start with registration at 09:30am and finish by 4:30pm

Mind reserves the right to make changes to the programme advertised without prior notification