CONFERENCE / STUDY DAY BOOKING FORM
Name of Event:
Funeral Director’s Study Day “Involving Children with Funerals”.
Date of Event:
Wednesday 19th March 2014
Delegate Rate:
£35
Title – Mr/Miss/Ms/Mrs/Dr or other:
First Name & Surname:
Occupation:
Organisation (place of work):
Work or Home Address (indicate
preferred address for correspondence):
Home:
Work:
Work, Home and Mobile Telephone
Numbers:
Home:
Work:
Mobile:
Email Address:
Please specify any mobility, audio or
visual requirements:
Ethnic Origin:
How did you hear about this training?
Please place X here if you DO NOT WISH to
be contacted by Child Bereavement UK with
information about future training:
METHOD OF PAYMENT
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(Please select and complete details below)
I enclose/willsend a cheque made payable to “Child Bereavement UK”
I would like to pay by credit card – please book online via our website
I would like to pay by BACS payment – see details below
Please send an invoice to my organisation – please complete details below
Invoice details:
Contact name & address for invoicing (If different from above):
Purchase Order Number:
BACS Payments: Sort Code: 30-16-74 A/C No: 00099864 Bank: Lloyds TSB Private Banking
A/C Name: Child Bereavement UK (Invoice number to be quoted at the time of payment – please request)
NOTE: If you would prefer to book by credit card over the phone, please call Training on 01494 568911. We
do not store credit card details once a payment has been processed.
When completed, please return by post to: Child Bereavement UK, Clare Charity Centre, Wycombe
Road, Saunderton, Buckinghamshire HP14 4BF or email conferences@childbereavementuk.org or
fax 01494 568920
Registered as a charity in England and Wales: 1040419 & Scotland SCO42910