Summer 2019 Booking form: Animal Assisted Therapy in Counselling (Telford, 3 Day Course)
Saturdays 14th September, 19th October & 16th November 2019
Exotic Zoo CIC, Lakeside Plant Centre, Priorslee, Telford TF2 9UR
* Required
Name: (Please put first name & surname as you want it to appear on your certificate)
*
Your answer
Address:
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Postcode:
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Phone:
*
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Email:
*
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DIET/ACCESS: Please indicate any special requirements overleaf, other than “vegetarian”, which we will cater for by default.
Your answer
ANIMAL ALLERGIES/ PHOBIA: If so, please specify.
*
Your answer
I will be paying the course fee of £399
*
Directly into HumAnima CIC's Bank Account (Santander Account Number: 45689583 Sort Code: 09-01-27)
via cheque or Postal Order made payable to “HumAnima CIC”, 67 Clark Road, Wolverhampton, West Midlands, WV3 9PA
via PayPal on the website
www.humanima.co.uk/services/courses/
Other:
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Other:
Do you have any additional special requirements?
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