Swimstart DVD Order Form Cerebral Palsy Sport has produced a DVD learning resource for swimming teachers, coaches, parents, companions, occupational therapists and physiotherapists as an introduction to swimming with cerebral palsy. This learning resource for swimming is one of the many ways we are working towards the vision that everyone with a physical disability is able to access the sport of their choice. The DVD contains information and advice on how to enhance the support provided to swimmers with a physical disability. By adopting the simple techniques demonstrated, you will improve the experience for swimmers with which you work by improving confidence when working with swimmers with cerebral palsy. Target Audience: Swimming Teachers & Coaches, Physiotherapists, Occupational Therapists, Parents/Guardians, Qualified Teachers and Teaching Assistants. Duration: Approx. 30 minutes.   Cost: £10 including VAT and delivery. Delivery outside of mainland Great Britain will incur a surcharge. Please contact the office for details. Ordering: To order a DVD, please complete and return the below to admin@cpsport.org or Cerebral Palsy Sport, Unit 5, Heathcoat Building, Nottingham Science Park, University Boulevard, Nottingham NG7 2QJ.

Swimstart DVD Order Form Purchase Order No: (If applicable) Number of DVD’s Required: Organisation: Contact Name: Invoice Address:   Post Code: Tel. No: Email: Delivery Address: (If different to the above) Add to Mailing List: Yes/No Interested in Membership: Yes/No Please return order form to: Cerebral Palsy Sport 5 Heathcoat Building Nottingham Science Park University Boulevard Nottingham NG7 2QJ Tel. no: 0115 9257 027 Email: admin@cpsport.org CP Sport Ltd. Is a Limited Company registered in England and Wales, no 04181593. Registered office as shown. Registered Charity No: 1088600. VAT no 845 2260 36

Swimstart DVD Order Form Cheque/payment must accompany the order unless ordering through Local Authority/Local Education Authority or other official ordering systems, with official purchase order numbers. Payment Options: Please invoice for payment I have made a BACS payment: Ref ………………………. (Account Name: CP Sport. Account number: 58689468. Sort Code: 30-95-42. Name of Bank: Lloyds) I have enclosed a cheque made payable to CP Sport I wish to pay by Credit / Debit Card (There will be a 2.4% surcharge on all payments by credit card) Card Type: Credit / Debit (please delete as appropriate) Card Number: (If you are returning this form by email, please call the office to pay rather than completing this section.) Card Start Date: _ _ / _ _ Card End Date: ­_ _ / _ _ Issue Number (Switch card only): _ _ Card Security Number: (last 3 digits on signature strip) Cardholder’s name and contact details (if different from above) Name: ……………………………… Address:……………………………… ……………………………………………………………………………………. ……………………………………… Post Code: …………………………… Email: ………………………………. Telephone: ………………….……….. Signature: ……………………….…. Date: ………………………….………. * Note: Unless clearly marked as payment by debit card it will be assumed that payment is by credit card and the 2.4% surcharge will be incurred. CP Sport Ltd. Is a Limited Company registered in England and Wales, no 04181593. Registered office as shown. Registered Charity No: 1088600. VAT no 845 2260 36