Study Event Booking Form

Name:	Date:
Address:	Tel Home: Tel Work:
Email:
Place of Work:
Special Dietary Requirements:
Event Name: ready, steady Breathe
Date of Study Event: 05 July 2012

BACCN Membership No:

Please reserve me _______ place/s for the above named study day/event.

I enclose a cheque for __________ Please make all cheques payable to: "BACCN Northern Ireland Region"

No bookings will be accepted unless accompanied by a cheque for the required amount or submited internet funds.


Send this form to Carol Waters Carol Waters Critical Care West Suffolk Hospital Hardwick Lane Bury St Edmunds Suffolk IP33 2QZ 1 Tel: 01284 712717 E.mail: carol.waters@wsh.nhs.uk