Booking Form

Course / A Four-Day Intensive Training Programme in Multi Family Therapy
For Health Professions working in Eating Disorders
Date / Tuesday 21 June 2016 to Friday 24 June 2016
Venue / Ortus, Maudsley Learning Centre – The Maudsley Hospital site
Cost / £975.00 per delegate

Please complete this booking form clearly in BLOCK LETTERS and return with PAYMENT DETAILS and a LETTER OF AUTHORISATION from your ORGANISATION IF YOUR ORGANSATION IS FUNDING PART OR ALL OF THE COST. Please return completed forms to: Charlotte Laxton, CAMHS Engagement Manager – by email to: or by post to: The Michael Rutter Centre The Maudsley Hospital Denmark Hill LONDON SE5 8AZ. For further information please telephone 0203 228 2693.

PERSONAL DETAILS PAYMENT DETAILS TERMS AND CONDITIONS

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:
Purchase Order number:
 I enclose a cheque for £…….…
to: SLAM NHS Foundation Trust
 Please debit the company Credit/Debit card for £……….
 Please debit mypersonal 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 self-funding 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)