Developing Real Change Leadership

Please print off, tick the appropriate box. complete your details and return the form to the above address. For additional participants please photocopy or reprint this form.

20th November 2003

This Workshop will take place at the Jury's Conference Centre, Broad Street, Birmingham. It will run from 9.30 a.m. to 4.30 p.m. at a cost of £150 per person. The price includes all refreshments, lunch and workshop materials, but not overnight accommodation. A room can be booked separately through the Hotel. Tel:

Name (Mr/Mrs/Ms) ___________________________________

Position: ___________________________________________

Organisation: ________________________________________

Address: ___________________________________________

___________________________________________________

Postcode:________________ * Order Code: ______________

* Cheque No(s). ___________________ Totalling £ _________

* Complete as appropriate. If you provide an Order No. an invoice will be sent to you.

Tel: _____________________ Fax: _____________________

Email: _____________________________________________

Signature: __________________________ Date: ___________

Faxback: 01386 861 841 Enquirires: 07866 731 231

* If you are paying by cheque, please make it payable to "S.R.Trivett" and attach it to this form. Send to: The Change Zone, 2 Thatched Cottages, Broadway Lane, Fladbury, Worcestershire. WR10 2QF

NOTE: Fees paid within 30 days of the event cannot be refunded.