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THE FAP Gene Support Group 5th Annual Informal Chat Day
Saturday
September 22nd 2012 10.00am to 4.30pm
The Branston Golf and Country Club
Branston - Burton upon Trent - Staffordshire Just off the
A38
Guest
Speaker Professor Robin Phillips MB BS MS FRCS
Director of The Polyposis Registry St. Mark's Hospital Harrow
For
Patients, Relatives, Friends, Health Professionals and others
with an interest in FAP
Organisers
John Roberts & Mick Mason (Patients with FAP) www.fapgene.com
Registration adults £5.00 - 16 and under Free to include
Hot Buffet Lunch
Registration
Form and Payment
Download
in PDF
Word
Rich
Text Formats
For
those who wish to attend, please complete the application
form below and return it with your Registration Fee and a
self addressed envelope by the 12th September 2012
The registration fee will include a
hot buffet and hot drinks during the day.
CAR
PARKING
There is plenty of free parking available.
I
will attend The FAP Chat Day on Saturday 22nd September 2012
NAMES
OF ATTENDEES: ………………………………………………………………………
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………………………………………………………………………
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ADDRESS
………………………………………………………………………
………………………………………………………………………
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TELEPHONE
NUMBER -----------------------------------------------------------------------------------
Mobile
Number (Optional) ………………………………………………………………………
If
E Mail Address (No SAE Required) ---------------------------------------------------------------------------
I
enclose the total sum of £………………(£5.00
per head and free 16 and Under)
Cheque/Postal
Order in respect of the Registration Fee Payable to FAP GENE
and a stamped self addressed envelope.
Signed ……………………………………………
Date ………………
Please
return this form to: John Roberts, 21 Clinton Street, Derby,
Derbyshire, DE21 6DH
Contacts:
John Roberts 01332-361234 johnroberts@fapgene.com
Mick Mason 01664-566101 mickmason@fapgene.com
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