Please pay the full registration fee of £300 +VAT (£360) with a cheque made payable to If you wish to pay by Pay Pal please contact BASHH If you wish your department to be invoiced please provide full invoicing instructions and a Purchase Order to cover the cost of your registration fee, contact SECTION 3 Please complete the all details below. This information is required for us to process your registration and set up your training record. Title (Dr, Mr, Mrs, Ms etc.) name Surname Your Job Title as stated in your job description (nurse/doctor is not sufficient information) Place of Work name of clinic, hospital or practice, – including postcode Correspondence address incl postcode To your certificate will be mailed Mobile telephone number Email NHS Trust Name of Registered STIF Intermediate Clinical Trainer to Clinical Trainer’s workplace Clinical Trainer's email Clinical Trainer's contact telephone number (This should be the number of the clinic) I confirm that the above Registered STIF Competency Clinical Trainer has agreed to [ ] undertake my training and take responsibility for overseeing the clinical sexual health competency assessments according to the requirements set out in the STIFIntermediate Competency Training Guide. [ ] I confirm you can retain the above information to set up my training record. Signed: Date: SECTION 4 Please return this form, keeping a copy for your files, with a cheque for the appropriate amount shown above made payable to to the following ‘BASHH’ address: BASHH
Please pay the full registration fee of £300 +VAT (£360) with a cheque made payable to If you wish to pay by Pay Pal please contact BASHH If you wish your department to be invoiced please provide full invoicing instructions and a Purchase Order to cover the cost of your registration fee, contact SECTION 3 Please complete the all details below. This information is required for us to process your registration and set up your training record. Title (Dr, Mr, Mrs, Ms etc.) name Surname Your Job Title as stated in your job description (nurse/doctor is not sufficient information) Place of Work – name of clinic, hospital or practice, including postcode Correspondence address incl postcode To your certificate will be mailed Mobile telephone number Email NHS Trust Name of Registered STIF Intermediate Clinical Trainer to Clinical Trainer’s workplace Clinical Trainer's email Clinical Trainer's contact telephone number (This should be the number of the clinic) [ ] I confirm that the above Registered STIF Competency Clinical Trainer has agreed to undertake my training and take responsibility for overseeing the clinical sexual health competency assessments according to the requirements set out in the STIFIntermediate Competency Training Guide. [ ] I confirm you can retain the above information to set up my training record. Signed: Date: SECTION 4 Please return this form, keeping a copy for your files, with a cheque for the appropriate amount shown above made payable to ‘BASHH’ to the following address: BASHH
STIF%20Intermed%20Registration%20Form.docx