GP Trainers WinterWorkshop
Cumberland Lodge
Wednesday – Friday
25th to 27thNovember 2015
PLEASE COMPLETE IN BLOCK CAPITALS – THANK YOU
PLACES ARE LIMITED AND WILL BE ALLOCATED ON A FIRST COME FIRST SERVED BASIS /
NAME:
PRACTICE NAME & ADDRESS:
TRAINER EMAIL: / PRACTICE MANAGER EMAIL:
TELEPHONE 1: / TELEPHONE 2:
PLEASE TICK AS APPROPRIATE: / COST / PLEASE TICK
OPTION 1
I wish to attend the entire workshopWednesday 25thNovemberto Friday 27th Novemberinclusive of all meals and overnight accommodation / £510
OPTION 2
I wish to attend the evening session on Wednesday 25th Novemberinclusive of the evening meal / £80
OPTION 3
I wish to attend the evening session on Wednesday 25th Novemberinclusive of the evening meal and overnight accommodation and as a day delegate on Thursday 26th November excluding dinner / £285
OPTION 4
I wish to attend as a Day delegate on Thursday26th Novemberexcluding dinner / £105
OPTION 5
I wish to attend Thursday 26th Novemberas aday delegateinclusive of the evening meal / £155
OPTION 6
I wish to attend Friday 27th November as a day delegate inclusive of lunch / £80
OPTION 7
I wish to attend Thursday 26th Novemberinclusive of all meals and overnight accommodation plus Friday 27th November as a day delegate inclusive of lunch / £285
TOTAL COST: / £
PLEASE ADVISE IF YOU HAVE ANY SPECIAL DIETARY REQUIREMENTS:

cheques should be made payable to “Health Education England”. A receipt will be sent to you in due course.

Cancellation Policy: If you need to cancel your place, please advise Julie Malvermi. For a refund to be payable, you are required to advise HEKSS with a minimum of 2 weeks notice to the event.

Please return this Application Form TOGETHER with payment to:

Julie Malvermi, HEKSS, 7 Bermondsey Street, London, SE1 2DD

Direct Line: 020 7415 3437 Email: