Event Booking and Registration - Booking

Personal Details

Title:

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

Address:

Please enter an address.

Please enter a post code.

I have additional access, communication or other requirements.

How did you hear about us?

Please tell us how you heard about us.

If Other please Specify

Payment Details

This section must be completed for all bookings including fully funded places

Cancellations within 7 days will attract an administration fee of £15. 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

Demographics

EOLP wants to meet the aims and commitments set out in its equality policy. This includes not discriminating under the Equality Act 2010, and building an accurate picture of the make-up of people accessing its services. The organisation needs your help and co-operation to enable it to do this. The information provided will be kept confidential and will be used for monitoring purposes only.

Gender:

Is the gender you identify with the same as your gender registered at birth?

Age Range:

Ethnicity:

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong.

Do you consider yourself to have a disability or health condition?

Sexual Orientation:

Religious Belief:

Do you have caring responsibilities? If yes, please select all that apply

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.

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.

Verification of Expected Death - 02/05/2024 11:00:00

End of Life Care Education Hub - Edith Reeves Suite