Please give your full name and email address:

Title:

First Names:

Surname:

E-mail:

Please use the following sections to give details of any changes or corrections. Items left blank will be assumed to be unchanged.
 

Address for sending Mailings and Journals:

Address:

Country:

Postcode:

Details for the On-line Directory

(To correct or change your address, please complete the address in full)

Address:

Country:

Postcode:

Tel:

Fax:

Email:

 as given above

 
Have you completed a CSP-recognised injection therapy course?

If Yes, please state which organisation organised the course:

Do you treat private patients?

Do you have facilities for lumbar traction?

Would you be available for locum work?

Please confirm: 

The Society may on occasions send out additional material which may be of interest to its members.

Do you wish to receive these mailings?

May we include your details in the Directory?

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