Interpersonal Therapy Workshop

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					                    BABCP Bipolar Disorder Special Interest Group
                                                  Annual Conference
                                                        24th April 2012
                                                    REGISTRATION FORM

Please complete in block capital letters:
Surname………………………………………………………. First name…………………………………………………… Title…………………
Profession ……………………………………………………………….. Daytime phone no …………...………………………………………
Mailing Address ................................................……..…………………………………...............…………….…………………….
..............................................................…………………………………………………………………...……………………………………
………………………………………………………. E-mail ………………………………………………………………………………………………….
Dietary requirements: Yes/No If you have answered yes please specify …………………………………………………..

     BABCP                           Service User               Clinical Psychology Student        Other

Registration fees (includes coffee, lunch and documentation)
      £50 (1 day) for BABCP members, Service Users and Clinical Psychology Students
      £75 (1 day) for non-BABCP members
Cheques should be made payable to BABCP OR Please invoice employing authority:

Contact Name …………………………………….......................................................……………………..

Department…………………………......................................................……………………………………

Address……………………………..........................................................…………………………………...

……………………………………..........................................................……………………………………
Tel. No..........................................…………   Order number………………………………………….

Confirmation together with maps will be sent as acceptance to the event after the necessary documentation has been
                                                        received and cleared.

                           All payments and completed registration forms should be sent to:


       Spectrum Centre for Mental Health Research, Division of Health Research,
                      Lancaster University, Lancaster, LA1 4YT
                                Telephone 01524 593756 : Fax 01524 592113

				
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