First Name :                                                     

Surname:                                                         

Home Address:                                                 

Home Telephone Number:                               

Work Address:                                                  

Work Telephone Number:                                

Health Trust/Authority:                                      

Email address:                                                  
Please give an email address if possible- we will use it for correspondence in preference to writing

Please select which course you are applying for below:

Working with Deaf People       Part 1             

 Working with Deaf People      Part 2             

 Working with Deaf People      Part 3             

PETAL Refresher Course                              

Grammar Course                                         

Semantics Course                                       

Assessing and Working on Speech Intelligibility with Deaf Children
                                                                  

Effective Presentation Skills                          

Other Course (please specify)                      

Other CSD Purchases:

PETAL Assessment:        £35 (incl. P&P)     

Checklists                                £15              

PETAL DVD                             £25              

For the PETAL assessment, checklists and DVD please make cheques for the appropriate amount made payable to
"CSD Consultants" and send to the CSD office:

25, Handen Road,
London SE12 8NP

Any Special Requirements (please give details):                    

To Submit or Reset the form click on the following: