Name Address Town/City County/State Post Code/Zip Code Telephone No.  (Daytime) Telephone No. (Evening) Email Address Interests  Medical Educational Parent If Parent your child's name                           Date of Birth Additional Information:-

The CCAA is a registered charity ( No. 1004200), run by parents and professionals Headquarters General Secretary:  Caroline Cox, Ground Floor, Amber Gate, City Wall Road, Worcester, WR1 2AH Tel: +44(0) 1905 745595 Fax:+44(0) 1905 745703  Email: info@ccaa.org.uk Hon. Patron:  Dr. Barbara M Ansell CBE, MD. FRCS, Hon FRCPCH. (Deceased) Patron:  Prof. P Woo PHD. FRCP. FRCPCH. Patron: Prof. T Southwood BM. BS. FRACP. FRCPA. FRCP. FRCPCH.