Please answer all questions as frankly and honestly as possible.
Your answers are handled in the strictest confidence and are to assist us in helping you on a course.
* denotes a required field
Your telephone number is very important to us, as we need to discuss your course with you. PLEASE ENSURE YOU INSERT IT ABOVE.
We do appreciate that the telephone is a problem for some people who stammer. However, please remember that we speak to more people who stammer, applying for a Starfish course, than people who do not. We are only interested in what you have to say, not how you say it.
Please answer all questions as frankly and honestly as possible, your answers are handled in the strictest confidence and are to assist us in helping you on a course.
To enable us to reach more people who stammer could you please tell us, how you heard about The Starfish Project ?
Starfish Project Courses are held regularly throughout the year. To enable us to schedule a suitable date for you please let us know dates that you are available for a course. We will then discuss a mutually convenient time with you.
Sometimes a course place is available at short notice, we will contact you if a place becomes available.
I wish to apply for a place on a intensive therapy course organised by The Starfish Project.
I confirm that I have read and understood the literature provided to me by The Starfish Project and that the information that I have provided will be treated in the strictest confidence by The Starfish Project.
I appreciate that though The Starfish Project has had a beneficial effect for other stammerers , it offers no guarantee of recovery from or a cure for stammering. The Starfish Project will not be responsible for any direct or consequential effects which may arise from my participation in its programme.