RADIATION PROTECTION AND QUALITY ASSURANCE
BOOKING FORM- 2015
DATE:15th to 17th OctoberMODULE 1 ONLY(Thursday) /
MODULES 1 & 2(Thursday and Friday)
MODULES 1, 2 & 3(Thursday, Friday and Saturday a.m.)
Due to the nature of the training we are unable to offer Module 2 or
Modules 2 & 3 as stand-alone courses.
FIRST NAME: / JOB TITLE:
DEPT: / ORGANISATION:
ADDRESS OF EMPLOYER:
ADDRESS FOR CORRESPONDENCE(IF DIFFERENT FROM ABOVE):
TEL NO:
E-MAIL ADDRESS:
Please specify your preferred method of contact *:
Post / E-mail
*Excluding delegate packs which will be sent through the post
PLEASE PRINT YOUR NAME AS YOU WOULD LIKE IT TO APPEAR ON YOUR CERTIFICATE OF ATTENDANCE
RADIATION PROTECTION & QUALITY ASSURANCE - 2015
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RADIATION PROTECTION & QUALITY ASSURANCE - 2015
METHOD OF PAYMENT
Due to the nature of the training, places are limited. To avoid disappointment early booking is recommended.
(VAT is not chargeable for this course)
Course fee –Module 1 only: £190.00
Module 1 & 2 only:£390.00
Modules 1, 2 & 3 only:£440.00
St George’s Healthcare NHS staff should contact RPC for details
A 10% discount will be applied to those delegates from hospitals or organisations for whom RPC acts as Radiation Protection Advisers.
Set of RPC Handbooks (see Course Information Sheet): £75.00
Please choose one of the following options.
1) / All cheques to be made payable to:St George's University Hospitals NHS Foundation Trust
2) / I enclose Purchase Order Numberfor
£ and wish the invoice* to be sent to:
Name of organisation
Address
Marked for the attention of
* All purchase orders to be raised to:
St George's University Hospitals NHS Foundation Trust
* Invoices cannot be raised without a valid purchase order number
3) / I wish to pay by BACS. A pro forma invoice will be provided if you choose this option.
(Payment must be cleared before your place can be confirmed.)
4) / I wish to pay by debit or credit card.
(Once your application has been accepted and in order to secure your place you should ring 020 8725 1051 with your debit/credit card details.)
5) / I am solely employed by St George's University Hospitals NHS Foundation Trust and will be providing an authorised cross charge form (available upon request.)
If you have any questions about the payment options, please contact Kathryn on 020 8725 1051
or email
I confirm that I have read and agree to the terms and conditions for RPC training courses.
Name: / Date:
SUPPLEMENTARY INFORMATION
Accommodation does not form part of this booking, but RIBA use an interactive hotel booking site which may helpwith your accommodation requirements.
There are also several Holiday Inn Express hotels within easy reach of the venue:
Please state any dietary or other special needs (if applicable)
On completion please return this form by;
Post– Course Bookings,
RPC, Unit 5, 24 Deer Park Road, London SW19 3UA,
Email –
Fax–+44 (0)020 8417 1338.
Your place is not guaranteed until you receive a formal letter of confirmation from RPC
RADIATION PROTECTION & QUALITY ASSURANCE - 2015
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