SSR Autumn 2006 Meeting

Active for Life

The Benefits of Exercise and Conditioning in Rehabilitation

Friday 17th November 2006

Westpark Conference Centre, 319 Perth Road, Dundee

Application Form

Name.........................................................................   Profession................................................
Address (for correspondence).....................................................................................................

.........................................................................................................................................................
Address (if different for delegate list) ......................................................................................... .

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Telephone.......................................................................  Fax......................................................
Email  ....................................................................................................................................

Please tick appropriate box

Student/Retired:

£15  
      
 
Member SSR:            £35  
     
(Membership no. must be given ............................... )
Corporate Member SSR:  £35
     
(Membership no. must be given ............................... )
Non-member SSR: £50
     
 
Special Dietary Needs  ...........................................................................................
Other Special Needs  ...............................................................................................
How did you hear about this meeting?  ...................................................................

I enclose a cheque for £........... made payable to the 'Scottish Society of Rehabilitation'

Please note that payment must be made with application. We cannot issue invoices for this event. A receipt can be provided if required.
 

Signature ...................................................................                        Date......................

Please return completed form by 10/11/06 to:

Moira Colvan, Administrative Secretary, SSR, 24 Kingsland Drive, Glasgow, G52 2NE