Event Registration Form
Please complete a separate booking if you are applying for more than one event or if there is more than one delegate.
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Event Details
Event:
-- Select --
Please select an event.
Date:
-- Select --
Please select an Event to see avaialble dates.
Please select a date.
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Personal Details
Please provide the details of the person attending training as this will be used for the NHS Track and Trace system if required. Bookings that do not provide full details may be rejected.
Title:
--Select--
Mr
Mrs
Miss
Ms
Dr
Prof
Rev
NA
Please select a title.
Forenames:
Please specify a Forename.
Surname:
Please specify a Surname.
Email:
Please enter a valid email address.
Phone:
Please enter a phone number
Job Title:
Please enter a Job Title
Place of Work:
Please enter the name of your employer
No acronyms please
No acronyms please
Address:
Please enter an address.
Please enter a post code.
I have special access, communication or dietary requirement
(Please be aware that if the venue for your study event is Spring Farm the room for education is located up a flight of stairs. If you have mobility issues you may choose to move your booking to an alternative venue.)
How did you hear about us?
1 - Electronic Prospectus
2 - Email
3 - Poster
4 - Website
5 - Word of mouth
6 - Other, Please State
Please tell us how you heard about us.
If Other please Specify
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Payment Details
This section must be completed for all bookings including fully funded places
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Cancellations within 7 days will attract an administration fee of £15.
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Cancellation on the day of the course will attract the full course fee.
Non-attendance on the day will attract the full course fee (however named substitutes may be made).
*For fully funded places, you will only be invoiced in the circumstances detailed above. All cancellations must be received in writing or via email.
Forenames:
Please specify a Forename.
Surname:
Please specify a Surname.
Email:
Please enter a valid email address.
Phone:
Please enter a phone number
Job Title:
Please enter a Job Title
Address:
Please enter an address.
Please enter a post code.
Use Above Address?
Purchase Order Number
(If Applicable)
Voucher Code
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Consent
I confirm that I have read and understand the cancellation and non- attendance terms and conditions listed above
Please accept the terms and conditions.
I confirm that I will
not
attend face-to-face training if:
I am confirmed or suspected as having COVID-19 within the 14-days prior to the training session/event.
I have or experience any of the following symptoms; within the 14 days prior to attending the face-to-face training session: High temperature, Dry, persistent cough, Anosmia – loss of taste and smell, Sore throat, Headache and body aches, Chills, Diarrhoea, Difficulty breathing, Feeling weak, Blocked nose
If a member of my households has symptoms of or tests positive for COVID-19 within the 14-days prior to the training session/event.
If I or a member of my household have been contacted by the NHS Track and Trace and asked to self-isolate in line with current government guidelines.
Please accept the terms and conditions.
EoLP does not pass personal data to third party organisations except in circumstances outlined in our
Privacy Policy
, but may wish to keep you informed of educational news, activities and future courses etc. If you
wish
to receive this information, please accept here.
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If you have any queries about the data we hold or wish to have your data removed/anonymised please contact us at
Info@eolp.org.uk
with the details of your query. For more information on how we use you data please refer to our
Privacy Policy
Please correct the errors in your booking
Submit Booking Request