The Tavistock Institute

Organisational Understanding

and Reflection Group

for Senior Practitioners

10 meetings from February2014 – April 2015

Every first Tuesday of the month

APPLICATION FORM

Surname(s):………………………………………………………… Title:Mr/Ms/Dr/Rev/Other ……

Forename(s)……………………………………………………...…Age: ……………

Nationality: ………………………………………………………...... Male/Female

Organisation: ………………………..……………………………………………………………..…..…….

Official Title of Present Post:………………………………………………..……………………..………

What does your organisation do? ………………………………………………..………………………..

Business Address: ………………………………………………………………………………………….

…………………………………………………………………………...... ……

Tel No: ……………………………………………Mobile: ………………………..……….…………

Email:………………………………………………Website:……………………..……….………….

PrivateAddress:…………………………………………………………………………………………..…

…………………………………………………………………………………………...…………………….

Tel No:……………………………..………………… Email: …………………..…………………………

Preferred address for email: work /private posted mail: work/private

Please tick this box to be excluded from the Tavistock Institute database (for TIHR use only)

To reserve your place:Please return this application form with yourdeposit of £200.

Working rooms are situated on more than one floor. Specify any special requirement(s) relating to disability: ………………………………………………………………………………………………..

How did you hear about this course?

Invitation: …………………………………………………………………………………………………………………

From a colleague or friend, named: ………………………………………………………..……….….…………..…

Website – Tavistock Institute or other: ...... ……………………….…………….……..…………………..

Advertisement: Journal / brochure / leaflet ……………………………………………….....…………...…..………

Other: ……………………………………………………………………….……………………………….……………

3. PAYMENT:please refer to the Terms and Conditions on the next page

Membership fee:

£250 (plus VAT) for one event; total £250. If an individual attends 5 events on this basis, they would pay a total of £1,250. The higher costs reflects higher administration costs for TIHR plus covering set up costs but it provides flexibility for the attendee if they are uncertain as to how many sessions they might attend.

£225 (plus VAT) for five events; total £1125. This represents a saving to the attendee of £100 if they attend all 5.

£180 (plus VAT) for all 10 events; total £1800. This represents a further saving of the employee of £225 compared to purchasing a block of five sessions.

ADeposit:

I enclose / am sending£200for mydepositwith my application:

Cheque Bank draft ……..……….. (date)

Credit card (2.5% or 3.5% bank charge)Bank transfer……..……….. (date)

Credit Card No: Card type:

Expiry Date:Security code (3-digits):

Address to which it is logged: private / work / other:

BBalance of Fee:

I wish to pay the balance by credit card on (date): ………………………or

Please send an invoice for the balance to my work / private address or to:

Attn: ……......

......

CSignature:

I understand that this application constitutes the contract between The Tavistock Institute of Human Relations and myself. I have read the Terms and Conditions.

Signature of applicant:…….…..…………….…...... Date:………………

Applications to be sent to:

Rachel KellyEmail:

Conference Administrator

The Tavistock Institute of Human RelationsTel: +44 (0)20 7457 3927

30 Tabernacle Street

London EC2A 4UE, UKFax: +44 (0)20 7417 0566

OUR Terms and Conditions

The following information is intended to provide you with information on the fee and payment methods available and withdrawal and cancellation terms.

1. Deposit

A deposit of £200 is required on submission of all applications. Applications will not be considered without the deposit. An invoice will be issued for the deposit. A further invoice will be issued for the balance of the cost of the conference if the application is successful

2. Unsuccessful applications

The Institute reserves the right to decline applications for any reason. If the Institute declines the application the deposit will be reimbursed.

3. Date for applications

Applications will be accepted on an ongoing basis until February 2015.

4. Fee

£225 (plus VAT) for five events; total £1125. This represents a saving to the attendee of £100 if they attend all 5.

£180 (plus VAT) for all 10 events; total £1800. This represents a further saving of the employee of £225 compared to purchasing a block of five sessions.

5. Payment of the balance

Please send your deposit (£200) with your application form. On reservation of your place, it will be reserved until 28 days after the date of the final invoice or 27 March 2014 whichever is the earlier, during which time the balance of your fee must be paid in order to confirm your place. After 27 March if the balance of your fee has not been paid, we reserve the right to offer your place to another participant.

Bank transfers: Pounds sterling only. Please contact the Pre-Conference Administrator for our bank details. Ensure that your bank transfer clearly states both your company or personal name and invoice number in the Reference section and that the amount includes all bank charges.

Credit Cards: you may add your cc details to the application form or please telephone or fax the Administrator if paying by credit card – Visa, Mastercard and Amex. An extra (non-refundable) charge of 2.4% for Visa and Mastercard or 3.5% for Amex is made to all credit card payments to cover bank charges.

Cheques/Bank drafts should be made payable to The Tavistock Institute and payment should be in Pounds Sterling only. Cheques should be drawn on a bank in the United Kingdom. Bank drafts in sterling currency are available from most banks. Please note that Eurocheque transactions are not accepted. If sending a cheque separately from the application form, write your name on the back or indicate clearly whom it is from.

6. Venue

The OUR meetings will take place at The Tavistock Institute of Human Relations. Refreshments (tea/coffee and biscuits) will be provided. Participants are responsible for anymeals.

7. Cancellation & withdrawal from the conference charges

If you do not attend your allocated session/s, the fee is not reimbursable.

Invoice No: L Project: Dept: 6794Date received: