Therapy and Rehabilitation Services
Queen Square Division
Application Form
BBTA An Introduction to the Bobath Concept 2017
24th and 25th March
5th and 6th May
2nd and 3rd June
(Each module – full day Friday / half day Saturday)
The National Hospital for Neurology & Neurosurgery
Queen Square, London WC1N 3BG
Name: ……………………………………………………… / Professional Title: ……………………………………..Work Address: ………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………..
Postcode: ……………………………………………
Email: ……………………………………………………………………………………………………………………………
Contact Tel No: ……………………………………
24th -25th March 2017
Module I / Human movement analysis as a basis of clinical intervention?
5th and 6th May 2017
Module II / The integration of postural control and selective
movement for functional activities – Part A
2nd and 3rd June 2017
Module III / “The integration of postural control and selective movement for functional activities”– Part B
Do you have any special requirements? / Yes/No / If yes, please specify: …………………………………
COURSE REGEISTRATION FEE: £525 for full course, 3 Modules, £175 for single module
PAY ONLINE ON OUR NEW PAYMENT WEBSITE: http://www.uclhcharitycourses.com
BACS Payment details: Coutts, 440 Strand, London WC2R 0QS, Account Name: UCL Hospital Charity,
Fund reference: 0529 Education Fund, Sort Code: 18-00-02, Account No: 08324 530,
Registered Charity Number: 229771 (Remittance Advice to address details below)
Cheque to be sent with application form* and made payable to “0529 UCLH Charity Fund”
Acknowledgements and receipts will be sent on confirmation of booking.
Return application form (and payment if paying by chq) to: Alkida Domi, Therapy Services, Box 113,
The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG or by
Email: ph: 020 3448 3476 fax: 020 3448 3711
*Places will not be confirmed until an application form and payment have been received
PLEASE NOTE: / Cancellations are unlikely to be refunded except in exceptional circumstances, when a handling fee of 10% will be deducted. However, it is possible to send an alternative course participant.