2017 Edinburgh Clinical Trial Management Course #ECTMC17

Thursday 30th November Friday 1st December 2017

Title / First Name / Surname
Post held
Department
Organisation
Institution Address
Telephone number / Mobile
Fax number
Email address
Please give a brief description of your current role or previous experience in clinical trials
Please provide a question for “Question Time” (You will also be able to tweet your questions throughout the 2 days)
Special requirements (e.g. dietary, accessibility).
To assist with restaurant reservations, please indicate if you wish to attend the course dinner (cost NOT included in course fee - additional £25)
I would like to attend: (Y/N)
To assist with accommodation reservations, please indicate if you require accommodation and specify the dates required (Accommodation at Masson House - £62 per night)
I require accommodation: (Y/N
Please select the dates you require accommodation (please mark with an ‘X’):

Wed, 29 Nov Thurs,30Nov Fri, 01 Dec
£ / Amount
Course Fee (including course materials, lunch andcoffee)
NHS/Academic Rate: £525
Industry Rate: £1575
Course Dinner (on 30th Nov)Rate: £25
Accommodation: £62 per night
Course & Accommodation (1 night): £587
Course & Accommodation ( 2 nights): £649
Course & Accommodation (3 nights): £711
Total Amount Due
Please see below for course payment details. Please note that confirmation of a place and further course information will only be sent when full payment has been received. Cancellation prior to 20September 2017will incur an administration fee of £50.00.
No refund will be given for cancellations after this date, unless your place can be re-allocated.
Course Payment Details:
Pay online by debit or credit card / Please select the following link:

The Wellcome Trust Clinical Research Facility is listed under Conferences and Events, College of Medicine and Veterinary Medicine and then School of Molecular and Clinical Medicine
To pay for this course click the 'book this event' box
Enter your payment details as instructed
Pay by cheque / Please make out a cheque for the amount of the course, payable to the 'University of Edinburgh' and send it to myself at the address below.
Pay by Electronic Internal Transfer (EIT) / If you work for the University of Edinburgh.Please send EIT's to r the attention of Linda O’Neill or Susie Fong.
Invoice / We can raise an invoice for payment, but only in receipt of a purchase order from your finance department. Purchase orders should be marked for the attention of WTCRF and sent to the University of Edinburgh. Please also provide the details (Organisation name and address) of who will be paying the invoice.
Send your registration form to: Edinburgh CRF,Wellcome Trust Clinical Research Facility, The University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU. Email: Tel: +44 (0)131 537 3355