1. Course title: Syringe Pump
Course Date: 9th January 2020 Fee: £75 per person
Attendee details:
Name
Job Title
Address
Telephone
Professional group/area of practice:
Organisation:
Address:
Booking Conditions: The closing date for the application is 7 days prior to the start date. No refunds can be made after the closing date or where participants do not attend without prior notice to Education Adminstration. Your place on the course will be confirmed following receipt of your booking form and fee. In the event of a booking being cancelled less than two weeks before the course start date, 50% of the course fee will be charged. This form can be photocopied for additional applications. Those named above will be contacted with information about their course and other courses that may be of interest. All data received is processed in accordance with the Data Protection Act. Please view our privacy policy on our website for information about how we use your data, including how to opt out of further communication.
Payment Details: Please select your method of payment:
By Cheque. Please make the cheque payable to Saint Francis Hospice & place the course name on the back of the cheque
By BACS. Please Education Centre,
By Credit Card. Please call
By Invoice. Please invoice the following if different from the above address.
Name:
Address:
Signature: Date:
Data Collection Statement: Saint Francis Hospice is a local registered charity and believes it is in the best interests of local people to know about their hospice services available to them and associated funding needs. We believe that this is a legitimate interest and a justified basis for communicating with you. Information you provide will only be used for the legitimate interests of Saint Francis Hospice. Your information will not be sold, swapped, shared or leased with anyone. We may contact you, by post, including fundraising communications. We will respect your right to stop these communications at any time by calling or ing Our privacy policy is available on our website at or by request.
Please note: Your place on this course is not guaranteed until you have received confirmation from us in writing.
Please return form to: Post: Saint Francis Hospice, The Pepperell Education Centre, The Hall, Havering-atte-Bower, Romford, Essex, RM4 1QH. Call: