Registered Charity No. 1059686, Company No. 3268842 Application form Shape-Up Facilitator Training 2012 University College London
	Please reserve a place for me on the following date. The venue for all training will be University College London. Please complete a separate form for each person applying.
		Thur 14th June 2012
	I enclose a cheque for £195.00 made payable to 'Weight Concern' or
	Send an invoice for the full cost
	Invoice address ............................................................................................ .................................................................................................................... Delegate Name............................................................................................. Job Title ....................................................................................................... Contact address ........................................................................................... .................................................................................................................... Contact telephone number ........................................................................... E-mail ..........................................................................................................
	I agree this is a firm booking and that cancellation charges apply * Signature ................................................ Please return this form to: Training Enquiries Weight Concern 1-19 Torrington Place London WC1E 7HB *Cancellations more than 4 weeks prior to the course incur a 10% cancellation charge. Cancellations 2-4 weeks before the course incur a 50% charge. Cancellations less than 2 weeks before the course incur the full charge, but if the place is taken by another participant the charge is reduced to 50%.