Registration Form

Ann Conroy Trust

Support Education and Research

For those living with

Chiari Malformation, Syringomyelia and associated conditions

British Syringomyelia Chiari Group

Meeting booking form

          Please complete, and return to the postal address provided or to


Name: _______________________________                              Position: _________________________


Unit: _________________________________                             Hospital: _________________________






 Postcode: _______________________                                            E-mail: __________________________


        I wish to attend the meeting to be held


on: ____________________________________                               at: ______________________________


    I wish to pay by:

  • BACS transfer: 40-52-40; 00011969
  • Paypal -
  • Cheque* (enclosed)

   * Payable to Ann Conroy Trust     


Thursday evening:

I will be attending the evening dinner/I will not be attending the evening dinner

Please note, you will need to confirm your intention to join the evening dinner with the hotel, when you make your room reservation

If you wish to consult with the group about any particular case please contact the Charity on in advance of the meeting. 

Ann Conroy Trust CIO

registered in England number 1165808