Full name: *
Your current role:
Full title, dates & location of the course or conference you will be attending:
If you are presenting a poster or making an oral presentation please give the title of the presentation:
Please state how presenting or speaking at the conference will promote the exchange and development of knowledge on working with people with acquired brain injuries:
What are the likely costs of the event?
Please give details of any employer contribution or confirm that funding is not available from your employer:
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