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REGISTRATION FORM - Introduction to Music Therapy Meeting
Saturday 29the March 2008
Nordoff-Robbins Music Therapy Centre, 2 Lissenden Gardens, London NW5 1PQ
Please complete and send with s.a.e. (for receipt & directions) to: BSMT, 24-27 White Lion Street, London, N1 9PD, UK Tel: 020 8441 6226 mail: info@bsmt.org Please reserve for me :____ place(s) at £70 each
____ place(s) at £55 each ____ place(s) at £40each NAME: ................................................ ADDRESS: ............................................... ............................ Post Code .................. PROFESSION: . ................................................ TELEPHONE: ............................................... I enclose payment of ... ............................................. Cheques payable to BSMT please Payment may be made by Credit card: * indicate which MasterCard, Visa, American Express, Delta or Maestro Card No . If Maestro give Issue No. .. Card Security Number ______ This is the last 3 digits of the number printed on the signature strip on the back of the card Expiry Date: Signature: .
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