If you do not wish your name & organisation to Please invoice my organisation for be published in the course materials i.e. £……………… delegate list, please tick this box Service Manager: TITLE I enclose a cheque for £…….… Payment Terms to: SLAM NHS Foundation Trust Payment must be made in full and before the event. FIRST NAME Invoices can be issued to Please debit the company organisations for payment, on receipt of Credit/Debit card for £………. an official purchase order or letter of SURNAME authorisation from your manager/Trust Please debit my personal agreeing to finance your course fees. Credit/Debit card for £………. Payment can be made by cheque or credit card. JOB TITLE Card 1 Confirmation Bookings will be confirmed by email on ORGANISATION receipt of a completed application form Please circle and full payment of the course fee. Visa / MasterCard/ Switch/Maestro/ Delta Your application will not be processed [AMEX (American Express) NOT accepted] if any information is missing or a ADDRESS purchase order or letter of authorisation Please circle is not attached (a letter of authorisation is Company / Personal not required where individual is the full cost). Card number Cancellation COUNTRY All cancellations by participants must Expiry Date be made in writing to the above address, or by email to POST CODE Cancellations made no later than 14 3 Digit Security Code days prior to the course start date are eligible for a full refund. EMAIL Name and Signature of Cardholder (please print clearly) No refunds will be given for cancellations made within 14 days of the course start date. However, you can TEL NO. send a substitute delegate at any time. Any cancellations and substitutions must BILLING ADDRESS Card 2 be advised in writing (email to ). Please circle Visa / MasterCard/ Switch/Maestro/ Delta ACCOMMODATION Please circle YOU WILL NEED TO MAKE YOUR Company / Personal OWN ARRANGEMENTS but you – SIGNATURE Card number may want to look at: DATE (very near to Maudsley Hospital) Expiry Date SPECIAL REQUIREMENTS 3 Digit Security Code Please let us know if you have any special requirements e.g. dietary, Name and Signature of Cardholder wheelchair access etc /
If you do not wish your name & organisation to be published in the course materials i.e. delegate list, please tick this box TITLE FIRST NAME SURNAME JOB TITLE ORGANISATION ADDRESS COUNTRY POST CODE EMAIL (please print clearly) TEL NO. BILLING ADDRESS SIGNATURE DATE SPECIAL REQUIREMENTS Please let us know if you have any special requirements e.g. dietary, wheelchair access etc Please invoice my organisation for £……………… Service Manager: I enclose a cheque for £…….… to: SLAM NHS Foundation Trust Please debit the company Credit/Debit card for £………. Please debit my personal Credit/Debit card for £………. Card 1 Please circle Visa / MasterCard/ Switch/Maestro/ Delta [AMEX (American Express) NOT accepted] Please circle Company / Personal Card number Expiry Date 3 Digit Security Code Name and Signature of Cardholder Card 2 Please circle Visa / MasterCard/ Switch/Maestro/ Delta Please circle Company / Personal Card number Expiry Date 3 Digit Security Code Name and Signature of Cardholder / Payment Terms Payment must be made in full and before the event. Invoices can be issued to organisations for payment, on receipt of an official purchase order or letter of authorisation from your manager/Trust agreeing to finance your course fees. Payment can be made by cheque or credit card. Confirmation Bookings will be confirmed by email on receipt of a completed application form and full payment of the course fee. Your application will not be processed if any information is missing or a purchase order or letter of authorisation is not attached (a letter of authorisation is not required where individual is the full cost). Cancellation All cancellations by participants must be made in writing to the above address, or by email to Cancellations made no later than 14 days prior to the course start date are eligible for a full refund. No refunds will be given for cancellations made within 14 days of the course start date. However, you can send a substitute delegate at any time. Any cancellations and substitutions must be advised in writing (email to ). ACCOMMODATION YOU WILL NEED TO MAKE YOUR OWN ARRANGEMENTS – but you may want to look at: (very near to Maudsley Hospital)
Booking-Form-Systemic-Family-Therapy-Training-for-Anorexia-Nervosa-2015.docx