Talk Shop 2009 Booking Form

To book your place at the National Speech and Language Therapy Fair 2009 please fill in the form below. After you have filled in the form and pressed submit you will be taken to a payment page where you will have the choice of paying online using Paypal or requesting an invoice to be sent to your employers.

Alternatively you can download a booking form (by clicking here) which can then be printed off and send by post along with a cheque for Ł35 to the address on the bottom of the form.

BOOK NOW TO GUARANTEE YOUR PLACE

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address

Home Phone

Street Address*
Street Address*

City*
City*

County

Postcode

Current position:
(tick all that apply)

	NHS Therapist
	NQT Therapist
	Independent Therapist
	Student
	Assistant
	Adult acute/acquired
	Dysphagia
	Paediatric
	ALD
	Other

Additional requirements: Please list any additional requirements on the day, e.g. special dietary / access requirements

Where did you hear
about the Fair?

	Speech and Language Therapy in Practice
	Bulletin
	Flyer in department
	E-mail
	Friend
	Other

Information sharing:

Please tick this box if you do not wish us to share your details with some select companies affiliated with Speech and Language Therapy

Please enter the word that you see below.