Emergency and Pre-Hospital Care 6.11.

14: Application Form

Name:
BBA Member: Yes No (please tick)
If yes, BBA Membership No:
Profession:
Place / Area of work:
I work with: a!lts chilren both
"ork Aress:
"ork contact telephone no:
"ork email aress:
I enclose a che#!e for: $%& (BBA Member) (please tick)
$'& (non(BBA Member)
mae payable to !e "ritis! "#rn Association)
Or
I wo!l like to pay by creit car o*er the phone (please tick)) Please call me on
the followin+ n!mber:
I !nerstan that payments are non(ref!nable)
,i+ne: -ate:
o apply$ please ret#rn t!is %orm and payment$ &y Friday 1'
t!
(cto&er to:
Nechama .ewis, Mana+er, British B!rn Association, at the /oyal 0olle+e of ,!r+eons, 1& 2 %1 .incoln3s
Inn 4iels, .onon "05A 1P67 6mail: info8britishb!rnassociation)or+