Royal College of Psychiatrists Faculty of Medical Psychotherapy Annual Conference 2017

Wednesday 5-Friday 7 April 2017

RCPsych, 21 Prescot Street, London E1 8BB

Registration Form (BACS and cheques only)

PLEASE PRINT ALL DETAILS CLEARLY

£ Please tick here if you do not wish to have your name and town appearing on the delegate list. The College’s Data Protection Statement can be viewed at www.rcpsych.ac.uk/dataprotection

1.  Personal details (please complete in block capitals)

College membership number (if applicable):
Title:
/ First Name: / Surname:
Place of Work:
Mailing address:
Town:
/ Postcode: / Country:
Email:
/ Tel (Daytime):
Vegetarian:
YES/NO / Special diets:
Special Requirements:
Career Status (tick one box only):
r MEDICAL STUDENT/STUDENT ASSOCIATE
r PMPT
r CT/ST1-3
r CT/ST4-ST6
r FY DOCTOR / r NON-MEDICAL PSYCHOTHERAPIST
r ASSOCIATE SPECIALIST/STAFF GRADE/SpR/StR/SAS
r RETIRED
r CONSULTANT
r OTHER (please state):

2.  Registration fees

Fees include catering during scheduled programme breaks but do not include accommodation.

Standard Rate* / Reduced Rate** / Student Associate *** / Invited Speaker†
Whole Conference incl Wed Guest Lecture & Masterclass / £410 / £230 / £90 / £0
Thursday only / £185 / £95 / £40 / £0
Friday only / £185 / £95 / £40 / £0
Optional Extra: Master class Session (Wed 16:30–18:30) / £50 / £50 / £50 / £0
Optional Extra: Guest Lecture
(Wed 20:00–21:30) / £25 / £25 / £25 / £0
Optional Extra: Conference dinner
(Thu 19:30 – 23:30) / £50 / £50 / £50 / £50
TOTAL: / £

*The Standard Rate applies to Consultants/Locum Consultants, Non RCPsych members **The reduced fee is available to RCPsych Retired members, SAS doctors, SpR/StRs, ST/CT1-6 members, PMPTs, non-medical psychotherapists and delegates on the concessionary subscription rate of 50%.***Student associate rate is available to Student associates only. Student Associate membership is open to UK medical students and foundation trainees and is completely free – sign up here to take advantage of the reduced rates: http://www.rcpsych.ac.uk/discoverpsychiatry/studentassociates/aboutus/studentregistrationform.aspx

† Invited speakers are entitled to free registration on the day they speak only.

All registration confirmation letters will be sent via email. If you are unsure if your registration form has been received by us contact

3.  Parallel workshop/session attendance

Please indicate which parallel sessions and workshops you wish to attend, ranking your choices in order of preference. Spaces are limited and will be allocated on a first come first served basis.

WEDNESDAY 5 APRIL 16:30 – 18:30

1st Choice / 2nd Choice
wa. The nature of human suffering – an integration of psychotherapeutic and spiritual perspectives / ¨ / ¨
wb Working with Transgenders & Queers: Selves in Transition / ¨ / ¨

THURSDAY 6 APRIL 14:00 – 15:15

1st Choice / 2nd Choice / 3rd Choice
W1: DID / ¨ / ¨ / ¨
W2: A proposed continuum of dissociative disorders / ¨ / ¨ / ¨
W3: Trauma/dissociation and medically unexplained symptoms / ¨ / ¨ / ¨
W4: EMDR for the Psychiatrist: the basics to know about / ¨ / ¨ / ¨

Friday 7 APRIL 14:00 – 15:30

1st Choice / 2nd Choice / 3rd Choice
W5: Open Dialogue / ¨ / ¨ / ¨
W6: Psychodynamic Psychiatry; The Medical Psychotherapist and The Risk Management Panel / ¨ / ¨ / ¨
W7: Psychoanalytic principles in reflections on psychosis / ¨ / ¨ / ¨
W8: Cognitive Analytic Therapy, a relational approach to medically unexplained symptoms / ¨ / ¨ / ¨

4.  Payment

PLEASE NOTE THAT THE COLLEGE IS UNABLE TO INVOICE FOR REGISTRATION FEES

Places can only be reserved when payment is received with this form. If an authority is to pay, the delegate should either pay and then claim reimbursement from their authority or enclose payment from their authority.

□  Cheque: I enclose a cheque / postal order for £ ......

Please make payable to ‘The Royal College of Psychiatrists’ quoting reference MedPsych16 and the name of the delegate on reverse.

□  BACS: I enclose remittance advice form for £ ......

Bank details below. Places can only be reserved when remittance is received with this form.

Account name: The Royal College of Psychiatrists Account number: 40201340 Sort Code: 20-06-05

IBAN: GB31 BARC 2006 0540 2013 40 Swift Code: BARCGB22

DATA PROTECTION STATEMENT

The College’s Data Protection Statement can be viewed at http://www.rcpsych.ac.uk/dataprotection

Please complete and return your registration form with your payment to:

Virali Shah

Centre for Advanced Learning and Conferences (CALC)

RCPsych, 21 Prescot Street, London E1 8BB

E:

T: 0203 701 2622

F: 0203 701 2761

CANCELLATION POLICY

(Notice must be given in writing by post or e-mail

To be entitled to a refund all cancellations MUST be received in writing no later than 2 weeks prior to the event date. An 80% refund will be given if cancelled more than 4 weeks prior to the event and 50% refund if less than 4 weeks’ notice is given. No refund will be given if cancellations are received within 2 weeks before the event.

Should you be unable to attend, a substitute delegate is welcomed.