Paediatric Palliative Care Foundation Programme

Course application form
This is a 2 day taught programme with additional online learning (approx. 7.5hrs).
Please note: Both days must be attended. The online learning has been designed to complement the course, and participants are required to complete these activities prior to starting the course, and between the two taught days. Also The RCN cannot confirm competence of any practitioner.
The programme is £250 per person, and includes refreshments: tea/coffee & a sandwich lunch.
Early Bird rate of £225 if you book before the 2 February 2018 or if multiple bookings are made at once.
To book your place please complete this form and return it with payment details to:
Sarah Wimhurst, Office Administrator, Education and Training Centre, Level 2, Weston House, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street London WC1N 3JH, tel: 0207 813 8301 email:
All bookings must be paid for in advance. Provisional bookings are not confirmed until payment is received. A confirmation email will be sent to the address provided to confirm your place.
Course dates : / 1 and 15 March 2018 / 18 October and 9 November 2018
Full name: / Telephone number:
Work/mobile
Work email address:
Please provide / Other email address:
Please tick if preferred
Organisation: / Current position:
NMC Pin: / Dietary requirements
Please specify
Payment details:
A cheque should be made payable to: GOSH OR
Enter billing details below
Contact Name:
Contact email address:
Address/Organisation:
Purchase number if applicable:
Cancellation and Non-attendance Policy:
·  Cancellations must be received in writing/email 10 working days prior to the start of the event.
·  Name transfers from the same organisation will be accepted when confirmed in writing/email.
Non-attendance on the programme will incur a fee of £250.
Office Use Only / Form No / Cheque/ invoice / Date Received / Charges Total / Date Confirmation Sent / Date to finance