The Compassionate Mind Foundation Promoting wellbeing through the scientific understanding and application of compassion An Introduction to the Theory and Practice of Compassion Focused Therapy for Shame Based Difficulties presented by Dr Chris Irons When: Mon 2nd to Wed 4th March 2015 Where: 18 Royal Terrace, Edinburgh EH7 5AQ Please complete the following details and return the form to Jane Redford at jane.redford@compassionatemind.co.uk Your Details Title (Dr/Mr/Mrs/Miss/Ms)……………………… First Name……………………………………………................................ Surname………………………………………………………………… Job Title…………………………………………………………………. Email address……………………………………………………………………………………………………………………………………………. (Please write your email address clearly as booking confirmation will be sent by email) Postal Address………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………………………………….. Telephone Contact No……………………………………………………………… Please specify any special dietary requirements……………………………………………………………………………………… Workshop Fees: Early Bird Rate: £345.00 (if payment received by 12th January 2015) Normal Rate: £405.00 Student Rate: £250.00 (limited student places available) Payments can be made by cheque or bank transfer. The payment details will be provided on an invoice which will be emailed with your booking confirmation. If place is to be funded by an Organisation please ensure you provide a Purchase Order Number to be obtained from your funder’s Finance Department._________________________ Funder Details: Contact Name………………………………………………………………Contact Email………………………………………………....... ..................................................................................................................................................................... Organisation Name…………………………………………………………………………………………………………………………………… Address…………………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………………………………….. Terms and Conditions: Refunds, less a 20% administration fee, will be made if cancellations are received in writing up to ten weeks before the Workshop. Any cancellations received after this time will not be eligible for a refund. We regret, refunds for failure to attend cannot be made but substitute delegates are welcome at any time. Please indicate you have read and agree to the above Terms and Conditions Signed........................................................................ ……………………… Dated...................................................................... www.compassionatemind.co.uk