Please tick which session(s) you wish to attend: Communication Skills 23rd Jan 2018 – Loss & Transition 30th Jan 2018 – Assessment & Management of Pain 6th Feb 2018 – Symptom Assessment & Management 27th Feb 2018 – Spiritual Care 6th March 2018 – Surname: Dr, Mr, Mrs, Miss, Ms (please delete as appropriate) First name: Place of work: Job title: Address for correspondence: Postcode: Work telephone: Fax: e-mail: Home or mobile contact number: FULL DAY COURSES ONLY Please specify any special dietary requirements: – DO YOU HAVE ANY SPECIAL NEEDS? Please specify e.g. wheelchair access – WHO IS PAYING THE COURSE FEE? Myself Employer Other (give details below) (give details below) Please tick appropriate box Please give full details and address where the invoice for the course fee should be sent:- Cheque for fee enclosed: Please make cheques payable to Dorothy Tick if appropriate House Hospice Care Name person authorising expenditure: Signature of person authorising expenditure: Attendee signature: Date: Return completed form to: The Education Department, Dorothy Winsley, Bradford on Avon, Wiltshire BA15 2LE or by e-mail to: education@dorothyhouse-hospice.org.uk
Please tick which session(s) you wish to attend: Communication Skills – 23rd Jan 2018 Loss & Transition – 30th Jan 2018 Assessment & Management of Pain – 6th Feb 2018 Symptom Assessment & Management – 27th Feb 2018 Spiritual Care – 6th March 2018 Surname: Dr, Mr, Mrs, Miss, Ms (please delete as appropriate) First name: Place of work: Job title: Address for correspondence: Postcode: Work telephone: Fax: e-mail: Home or mobile contact number: FULL DAY COURSES ONLY – Please specify any special dietary requirements: DO YOU HAVE ANY SPECIAL NEEDS? – Please specify e.g. wheelchair access WHO IS PAYING THE COURSE FEE? Please tick appropriate box Myself Employer (give details below) Other (give details below) Please give full details and address where the invoice for the course fee should be sent:- Cheque for fee enclosed: Tick if appropriate Please make cheques payable to Dorothy House Hospice Care Name person authorising expenditure: Signature of person authorising expenditure: Attendee signature: Date: Return completed form to: The Education Department, Dorothy Winsley, Bradford on Avon, Wiltshire BA15 2LE or by e-mail to: education@dorothyhouse-hospice.org.uk
Single-EoLC-Study-Days-Flyer.docx