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I wish to attend the Weekend Workshop ‘An Introduction to Group Analysis’ on June 5, 6, 2009.
I enclose a cheque for £…………….. payable to F Dalal
(Cancellations: full refund before May 1, no refunds after May 1
Title: _______ First Name: ________________________ Surname: ___________________________________
Address (including full postcode): ______________________________________________________________
__________________________________________________________________________________________
Telephone Day: __________________________Evening: _______________________Mobile: _______________________
The following information will help us organize group membership.
Age: Gender: Profession: Ethnicity:
If you know another participant attending the programme, please let us know who, so that we can try to ensure that you are not in the same group:
Please indicate any previous group experience on the rear of this form. Signature: Date
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