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Please note that the Sheffield 2003 Conference is only open to SHASTD members.
It is taking place Friday 11th April- Sunday 13th April

Name:

Clinic Name and Address:

Telephone:

MSF 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

Are you a smoker?

yes    no

Are you willing to share a room?

yes    no

If yes, name of sharer 

Will you be staying for lunch on Sunday, 13th April?

yes    no

Your comments or question:

Your e-mail address

 

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

  electronic mail
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