Address: Postcode: Telephone: Mobile: Email: Special dietary or other requirements: PAYMENT METHOD (Please tick your chosen method) Cheque: Please make cheque payable to The Royal Hospital for Neuro-disability and send for the attention of Phili Denning Credit Card: payments by credit or debit card are welcomed. Please call 0208 780 4500 x5141/5140 to pay securely over the phone. Invoice: PO or other reference number: Invoicing address: Accounts payable contact email: Accounts payable contact tel: BACS Please send to the following Natwest Bank, RHN General Account ☐ Sort code Account no. Please send your BACS remittance form as confirmation of payment. Your BACS reference: If you are not self-funding please confirm who has authorized your attendance at this course and the funding: Name: Position: Contact email: Tel: MATADOC Training - Registration form March 11 13 2019 – Delegate fee (£350) Please return this form (one per applicant) to Phili Denning, Academic Event Manager at or by post: – Royal Hospital for Neuro-disability, West Hill, Putney, London SW15 3SW United Kingdom Venue: Royal Hospital for Neuro-disability, London. Conference fees include refreshments and lunch Cancellations/refunds: A refund, less 20% administration fee will be made if cancellations are received in writing at least 4 weeks before the course. We regret that refunds cannot be made for cancellation or non-attendance after this time. Substitute attendees are welcome at any time.
Address: Postcode: Telephone: Mobile: Email: Special dietary or other requirements: PAYMENT METHOD (Please tick your chosen method) Cheque: Please make cheque payable to The Royal Hospital for Neuro-disability and send for the attention of Phili Denning Credit Card: payments by credit or debit card are welcomed. Please call 0208 780 4500 x5141/5140 to pay securely over the phone. Invoice: PO or other reference number: Invoicing address: Accounts payable contact email: Accounts payable contact tel: ☐ BACS Please send to the following Natwest Bank, RHN General Account Sort code Account no. Please send your BACS remittance form as confirmation of payment. Your BACS reference: If you are not self-funding please confirm who has authorized your attendance at this course and the funding: Name: Position: Contact email: Tel: MATADOC Training - Registration form March 11 – 13 2019 Delegate fee (£350) Please return this form (one per applicant) to Phili Denning, Academic Event Manager at – or by post: Royal Hospital for Neuro-disability, West Hill, Putney, London SW15 3SW United Kingdom Venue: Royal Hospital for Neuro-disability, London. Conference fees include refreshments and lunch Cancellations/refunds: A refund, less 20% administration fee will be made if cancellations are received in writing at least 4 weeks before the course. We regret that refunds cannot be made for cancellation or non-attendance after this time. Substitute attendees are welcome at any time.