Please select and print this out, or answer the questions on a separate sheet of paper, and return to the organisers at the address below. Please mark the envelope clearly 'EATc 5'.

Fifth Exeter Arts and Therapy Conference:
�The Spaces Between�
Saturday March 12th 2004.

I would like to attend the conference.

Name:

Contact: (Address, phone and e-mail where possible please. Please print very clearly)

Please specify any other dietary requirements. Excellent vegetarian lunch is included. Please let us know if you have any other requirements, (e.g. disabled access)

We would like to prepare a contacts list for the conference. Please add a few words (max. 50) on the other side of this about how you would like to be identified on this, your role and areas of special interest. We will only use e mail addresses on this unless specifically directed otherwise. Indicate here if you would not want to be included in this.

Enclose a cheque, payable to 'Exeter Arts and Therapies Conferences' for �80 or �60 (concessions) and an S.A.E. If you require a receipt, please say so. If you want an invoice please say to whom it should addressed.

If you would like to apply for a concessionary place, please attach a note explaining why. Priority will be given to students and unemployed applicants. Please enclose photocopy proof of student ID etc.

If you have to cancel please let us know ASAP. All cancellations are subject to an administration charge of �5. We'll try to fill any cancellation spaces and refund the balance, but may not be able to. After March 5th, places cannot be refunded.

Please return this to:
EATc @ Insider Art, PO Box 272, St Thomas Exeter EX2 9ZL.

E mail karen@insiderart.org.uk
01392 677258

Applications by March 1st please.

Supported by:
The Champernowne Trust for Psychotherapy and the Arts,
Arts Council England,
The British Association of Art Therapists,
Insider Arts.