Psychoanalytic Observational Studies in Liverpool: An Introductory 5 ...
Psychoanalytic Observational Studies in Liverpool: An Introductory 5 ...
Psychoanalytic Observational Studies in Liverpool: An Introductory 5 ...
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<strong>Psychoanalytic</strong> <strong>Observational</strong> <strong>Studies</strong><br />
<strong>in</strong> <strong>Liverpool</strong>:<br />
<strong>An</strong> <strong>Introductory</strong> 5 Week Course<br />
Application Form<br />
Venue: Mulberry House, Alder Hey Hospital | Cost: £95 for five sem<strong>in</strong>ars<br />
Personal Details:<br />
Title: ……….. Name: …………………………………………………… Occupation: …………………………………………………..<br />
Email Address: …………………………………………………………………………………………………………………………………………….<br />
Address for correspondence: ……………………………………………………………………………………………………………………..<br />
………………………………………………………………………………………………………….<br />
Postcode: ……………………………….<br />
Telephone: ………………………………………………………………………………………………………………………………………………….<br />
<strong>An</strong>y special requirements: …………………………………………………………………………………………………………………………..<br />
Course Fees/Payment:<br />
I enclose a cheque (made payable to Leeds and York Partnership NHS Foundation Trust) for £95<br />
Please <strong>in</strong>voice my organisation £95<br />
Contact Details for Invoice:<br />
Name: ………………………………………………………………… Job Title: ……………………………………………………………………<br />
Organisation: ………………………………………………………………………………………………………………………………………………<br />
Address: ……………………………………………………………………………………………………………………………………………………..<br />
Postcode: …………………………………………………………… Telephone: ……………………………………………………………….<br />
Purchase Order Number: …………………………………………………………………………………………………………………………..<br />
Please return this application form<br />
to:<br />
Naomi Humes<br />
NSCAP Bevan House<br />
34-36 Spr<strong>in</strong>gwell Road<br />
Leeds LS12 1AW