MASTERCLASS BOOKING FORM

To enrol on a Masterclass simply fill in both sides of this application

form and return to:

LCCH, 15 Connaught Square, London, W2 2HG.

The cost of each Masterclass is £82-25 (£70-50 for LCCH Students, BSCH

Members and EJCH subscribers), or £141-00 (117-50 for LCCH Students, BSCH

Members and EJCH subscribers) if enrolled for two Masterclasses. All prices

include VAT.

I am an LCCH Student and/or a BSCH Member

I am a European Journal of Clinical Hypnosis subscriber

I/We should like to enroll for the following Masterclasses

I/We enclose £.............................. for a single Masterclass.

I/We enclose £.............................. for two or more Masterclasses.

I understand that the fee(s) is refundable only if the Masterclass is cancelled. However,

delegates may transfer to any other date/venue. Cheques should be made payable to

MJ LECTURES and posted with the completed application form to the address above.

Name:.................................................................................................................................

Address:..............................................................................................................................

.....................................................................................Postcode: ......................................

Telephone/Home: ...................................................Work:..................................................

E-mail:.................................................................................................................................

METHOD OF PAYMENT

Cheque, to be made payable to LCCH Ltd

VISA / MASTERCARD

Number

Expiry Date

Signature...........................................................................................

Date.........................

London College of Clinical Hypnosis

Autumn 2003

28