Casting for Recovery

2010 Participant Application Form

Please complete this form if you would like to attend a CFR retreat and we will send you further information on forthcoming opportunities.

Title:

First name:

Last name:

Address line 1:

Address line 2:

Address line 3:

Town:

County:

Postcode:

Country

Home telephone:

Mobile Telephone:

Please select the retreats in your preferred order. You do not have to select more than your first preference.

^* Please note that :

retreat participants are selected randomly from the applications we receive for each, however where a retreat is over-subscribed we will give first preference to applicants resident in the country where the retreat is taking place

if you are successful in gaining a place on a retreat you may be required to share a twin room with another participant.

First Preference:
Second Preference:
Third Preference:

Please tell us about how you heard about us.

Newspaper/Magazine:
Radio:
Television:
Internet:
Member of the Medical Community:
Friend:
Other (Please specify):

Please use the box below to tell us of anything else that you feel would be relevant:

Your email address:

= Required