BOOKING FORM

I would like to attend the conference(s) in:   Belfast Manchester Rugby Bristol Wrexham Edinburgh

Topics I would like to explore at the conference(s) are:


    Name              Position  


   Address   

  Postcode      Tel    Fax 

  e.mail                      website       

The rest of the form does not apply to those attending the Belfast conference

I will send a cheque for         £                 payable to Value of Dialogue

Please send an invoice for     £             to  

Please charge       £    to my       Visa       Mastercard   (tick one)

Card No.                         Expiry Date  

Name on card      


Return to: Antidote, Fifth Floor, 45 Beech Street, London EC2Y 8AD
Fax: 020 7588 4900. Website: www.antidote.org.uk
or (for Belfast) to RTU, Balmoral High School, Black's Road, Belfast, BT10 OHT

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