Please note that any fields marked with an * are mandatory fields and must be completed.

Please complete with BLOCK letters

Terms and Conditions at the end of the Application Form

1. Programme Applied For: EXPLORING THE COMPLEX REALITIES OFINTER-AGENCY WORKING,A Group Relations Conference.

Programme Code:D42c

2. Personal Details

Please note that the name you give here will be the name printed on your certificate, therefore please give full first/given name, middle names and surname.

Title:*

Surname/Family Name:*

First/Given Name:*

Gender: Male or Female * (please underline)

Address: *

Postcode:*

Telephone Number (Daytime):*

Mobile Number:*

E-mail: *

3. Employment details

Job Title / Placement title:*

Employer Name/ placement details:*

4. Conference details*

Please tell us 3 issues, anxieties or words which relate to your personal experience of working in organisations and with children, families, young people and adults, which you would you like to explore within this conference?

An analysis of the issues and themes collected through members' responses will be used to inform a part of the conference, so the more personally resonant they are the better use we can make of them as a whole system.

(Please write 3 answers and not less!)

1*:

2*:

3*:

5. AdditionalInformation

Tavistock course code (if on any Tavistock course):*

…………………………………………………………………………………………………………………………

Special Requirements*(Please indicate here if you have any special dietary or disability needs):

…………………………………………………………………………………………………………………………

6. Payment Details* (please tick)Terms and Conditions are at the end of the Application Forms

The cost of the course is covered by my Course fee
please indicate which course
Please send me a link so that I can pay online
£650 for External Applicant
£550 for Internal Applicant
I am a staff member and would like to be considered for a subsidised place
Please note: There are 4 subsidised staff places at £275 which will be confirmed on a first come first served basis. All other staff members will receive 20% discount and pay £440
Please invoice my organisation(Please read payment terms below):
£650 for External Applicant
£550 for Internal Applicant
Address:

7. Please help us to improve our Marketing - How did you hear about this course?

f.) Direct Mail:YesNo

g.) Personal Recommendation:YesNo

h.)Website: YesNo

i.)Tavistock notice board: Yes No

j.) Advert/Other EventsYesNo

Where, Please specify: …………………………………………………………………………………..

8. Terms and Conditions

How to Book

  • Please complete this form, using BLOCK capitol letters (photocopy this form if more than one required, one form per person)
  • Return the completed form by email

Payment Terms

  • Payment must be made in full and before the event
  • Payments are to be made online. The conference administrator will send this link to applicants. A receipt will be generated once payment received.
  • Invoices can be issued to organisations for payment, on receipt of an official purchase order or letter from your manager confirming funding has been agreed
  • Invoices will not be issued without the accompanying paperwork
  • Invoices cannot be issued within 14 days prior of the conference date. All bookings made in this time must be paid in full at the time of booking.

Confirmation

  • Bookings will be confirmed on receipt of the a completed application form and full payment of the conference fee
  • Joining instructions will be sent to you by e-mail

Cancellation Policy

  • All cancellations must be made in writing to
  • All cancellations are subject to an administration charge of 10%of the conference fee
  • Cancellations made no later than 14 days prior to the conference are eligible for a full refund minus the administration charge
  • No refunds will be given for cancellation made within 14 days of the conference date
  • Please note Course leads and Conference Directors reserve the right to withdraw membership, or not agree to membership of a given conference, if there is evidence that attendance might adversely affect the prospective conference member and / or the experience of other members within the conference, if they were to attend.

Data Protection

The Trust does not make your details available to any external organisations. Your details will be added to our database to process your request and to keep you updated with relevant training and events; if you do not wish to receive this information, please tick the box

9. Student Declaration*

I commit myself to attending the whole conference 28th-31st March 2017

……………………………………………………………….. Signature

……………………………………………………………….. Date

Please return completed application form to Kara Florish, Group relations to

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