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Please note that the Conference is only open to SHASTD members


Clinic Name and Address:


Membership Number:

Do you require an invoice?

Yes    No

Name and address for invoice if different from above:

Are you vegetarian?

yes    no

Do you have any specific dietary needs? 

 yes    no

If yes, what are they?

Do you require disabled access?

yes    no

Do you require a signer?

yes    no

Do you require creche facilities?

yes    no

(These are available 9.30-5.30. Other times by negotiation)

If yes, how many children? 

Are you willing to share a room?

yes    no

If yes, name of sharer 

Will you be staying for lunch on Friday, 20th April?

yes    no

Your comments or question:

Your e-mail address


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           postal address:MSF Centre, 33-37 Moreland Street, London, EC1V 8BB.                      

  electronic mail: janef@shastd.org.uk

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