NAME........................................................................................................................................
ADDRESS....................................................................................................................................
......................................................................................................................................................
.......................................................................................................................................................
TELEPHONE...............................................................FAX..........................................................
E-MAIL.......................................................................................................................................
VENUE.........................................................................................................................................
DATE/TIMES:1st choice...........................................................................................................
DATE/TIMES: 2nd choice..........................................................................................................
Your application will be acknowledged and the date and venue confirmed by:-
CONTACT NAME (for the group)........................................ .............................................
NAME (of group/ organization)...............................................................................................
ADDRESS...........................................................................................................................
............................................................................................................................................
.............................................................................................................................................
TELEPHONE.................................................FAX..........................................................
E-MAIL.............................................................................................................................
SIZE OF GROUP/PARTY (30 max.)..................................................................................
VENUE :- "We would prefer use our facilities" Please tick YES /........./-- OR -- NO /.........../
VENUE :- "We would prefer psych-online to arrange the venue for us" .............YES /.........../
DATE/TIMES Proposed: 1st choice................................................................................
DATE/TIMES Proposed: 2nd choice ...............................................................................
Your application will be acknowledged and the date and venue confirmed by:-
NAME............................................................................................................................................
ADDRESS......................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
TELEPHONE................................................................FAX...........................................................
E-MAIL.............................................................................................................................
VENUE.......................................................................................................................................
DATE/TIMES:1st choice..................................................................................................
DATE/TIMES:2nd choice..................................................................................................
Space for question/comment ............................................................................................
.........................................................................................................................................
............................................................................................................................................
Your application will be acknowledged and the date and venue confirmed by:-
CONTACT NAME (for the group)...................................................................................
NAME (of group/organization).........................................................................................
ADDRESS.................................................................................................................................
...................................................................................................................................................
................................................................................................................................................
TELEPHONE...................................................FAX.................................................................
E-MAIL..........................................................................................................................
SIZE OF GROUP/PARTY (30 max.)................................................................................
VENUE:- "We would prefer use our facilities" Please tick YES /......../--OR-- NO /........../
VENUE:- "We would prefer psych-online to arrange the venue for us" .........YES /........../
DATE/TIMES Proposed:1st choice.................................................................................
DATE/TIMES Proposed:2nd choice ...............................................................................
Your application will be acknowledged and the venue and date confirmed by:-
NAME...............................................................................................................................
ADDRESS........................................................................................................................
...........................................................................................................................................
............................................................................................................................................
TELEPHONE.......................................................FAX........................................................
E-MAIL...............................................................................................................................
VENUE..............................................................................................................................
DATE/TIMES:1st choice.....................................................................................................
DATE/TIMES: 2nd choice....................................................................................................
Your application will be acknowledged and the date and venue confirmed by:-
CONTACT NAME (for the group)..........................................................................................
NAME (of group/organization)...................................................................................................
ADDRESS...............................................................................................................................
.................................................................................................................................................
.................................................................................................................................................
TELEPHONE....................................................FAX............................................................
E-MAIL..................................................................................................................................
SIZE OF GROUP/PARTY (max.40 )..................................................................................
VENUE :- "We would prefer use our facilities" Please tick YES /........./--OR-- NO /.........../
VENUE :- "We would prefer psych-online to arrange the venue for us" ............YES /.........../
DATE/TIMES Proposed :-1st choice......................................................................................
DATE/TIMES Proposed :- 2nd choice.....................................................................................
Your application will be acknowledged and the venue and date confirmed by:-
NAME..................................................................................................................................
ADDRESS............................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
TELEPHONE..........................................................FAX.......................................................
E-MAIL.................................................................................................................................
VENUE....................................................................................................................................
DATE/TIMES:1st choice..........................................................................................................
DATE/TIMES: 2nd choice........................................................................................................
Space for question/comment ..............................................................................................
...............................................................................................................................................
Your application will be acknowledged and the date and venue confirmed by:-