REGISTER
NB: fields marked [req] must be completed.
Please complete the form below and click 'Submit' to register.

 YOUR DETAILS
 
Title:    [req]
First Name:    [req]
Family Name / Surname:    [req]
Position:  
Organisation:    [req]
Address:    [req]
 [req]
Post Code:    [req]
Tel No:    [req]
Fax No:  
Email:    [req]
[Confirm] Email:    [req]
 
 DATA PROTECTION
   
  The Department of Health may wish to contact you with information on this or closely related subject matters. This information will not be given to any third parties for commercial purposes. If you do not want to receive such information please cross the box.
 
  Your name, position and organisation will be entered on to a delegate list which will be made available to all those attending the conference. If you do not wish to have your details used in this way please cross the box.
   
 SPECIFIC NEEDS INFORMATION
   
  If you require vegetarian food, please tick the box.
  If you have other dietary requirements (allergies,gluten free, vegan etc) please tick the box and we will contact you.
  If you have additional specific requirements (mobility, sight, hearing etc) please tick the box and we will contact you.
 
 EVENT DAYS
So that the event organisers are able to confirm accurate numbers for all aspects of the conference please state below which days you will be attending the event. (Please cross the box(es) of all that apply)
   
I will be attending the conference on Tuesday 27 November 2007
I will be attending the conference dinner on the evening of Tuesday 27 November
I will be attending the conference on Wednesday 28 November 2007
 
 DELEGATE FEES
 
Conference Fee:  [req]
 
In order that your invoice / payment may be dealt with promptly, please state your account reference or purchase order number below:
   
Account Ref: 
Purchase Order: 
 
Please indicate your preferred payment method:
 
Payment Method:   [req]
 
Credit / Debit Card Payments: If you provide your credit / debit card details we recommend, for security purposes, you download the Credit Card Guarantee / Payment Form (pdf), complete and fax your form back to us on +44 (0)1772 767501 rather than forwarding by email. Alternatively, please contact us on +44 (0)1772 767757 and we can take your card details by telephone. Credit / debit card payments will incure a 3.5% administration charge which will be added to your fee.
 
ACCOMMODATION
Glasgows will arrange your accommodation for Tuesday 27 November on your behalf. You are required to cover the cost of your accommodation (if required). You will also be responsible for settling any additional charges (room service, telephone, bar, mini-bar, films etc.) and will be asked to provide credit card details at the hotel on arrival. Please ensure your account is settled with the hotel on departure.
   
Accommodation required on Tuesday 27 November:

  [req]
 
If yes, please indicate your accommodation requirements by crossing the relevant boxes below. All rooms will be for single occupancy, feature a double bed and will be non-smoking (unless otherwise requested). A full English or Continental breakfast is also included in the rates quoted.

I would like accommodation reserved for me at the following hotel: (Please select the appropriate hotel)
   
Holiday Inn Regent’s Park
£146.88 incl VAT B&B per night
Euston Square Hotel
£94.50 incl VAT Bed and full English breakfast
   
Other accommodation requirements (please specify):
   
Please note: If you require additional nights accommodation you will also be responsible for payment of these nights. Additional nights cannot be guaranteed and will be on a request basis.

Guarantee of Rooms: We require you to provide your credit card details to guarantee your room. Payment will not be taken in advance and you will be asked by the hotel to present a credit card on arrival. We recommend, for security purposes, you download the Credit Card Guarantee / Payment Form (pdf), complete and fax your form back to us on +44 (0)1772 767501 rather than forwarding by email. Alternatively, please contact us on +44 (0)1772 767757 and we can take your card details by telephone.
   
 BREAKOUT SESSION
You will be able to attend one breakout session of your choice - please indicate below your first, second and third workshop choices in order of preference for each session:

Please note: You will be allocated your first choices wherever possible. As there are limitations on capacity within breakout rooms, all preferences will be allocated on a first come, first served basis. Should your first choice of breakout session not be available you will automatically be allocated your alternative choice.
 
1st Choice:   [req]
2nd Choice:  [req]
3rd Choice:   [req]
4th Choice:   [req]
 
 
  
 
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