THE AIREDALE BACKCARE FOR CHILDREN (ABC) PROGRAMME
WHAT, WHY AND HOW!

APPLICATION FORM
Please print and complete this form and return to

Airedale Physiotherapy and Sports Injury Clinic, 46 Devonshire St, Keighley, West Yorkshire. BD21 2BL.
e mail: airedalephysio@ aol.com Tel: 01535 611743.

Cheques made payable to David Cook. Thank you.

I would like to reserve a place on the 'ABC' Course held on ...../...../..... at ......................................................

I have enclosed a cheque for £.....................

Name & Address .................................................................................................

Profession ..........................................................................................................

Contact telephone or e-mail ................................................................................

The 'ABC' team will only contact you prior to the course in the event of cancellation.

Any special dietary needs ...........................................................................................................................

In the event of the delegate cancelling less than two weeks before the course, then a fee will be levied.