PHCSG 30
th
Annual Conference Registration Form
Primary Health Care SG
'Liberating the NHS - delivering the new information revolution'
11
th
- 13
th
October 2010, Crewe Hall, Cheshire
Mandatory fields are marked with an
X
Title
First Name
X
Surname
X
Job Title
Organisation
Address
X
X
Postcode
X
Telephone
X
Email
X
BCS/PHCSG Membership Number if Claiming Members Rate:
Special requirements:
Please tick this box if you are a Speaker.
CONFERENCE FEES
Please tick this box if you are a BCS/PHCSG Member:
BCS Member
£
(Inc VAT)
Non-member
£
(Inc VAT)
Monday 11
th
October - WELCOME BUFFET
20.00
20.00
Monday 11
th
October - ACCOMMODATION B&B En Suite
85.00
85.00
Tuesday 12
th
October - CONFERENCE DELEGATE
145.00
180.00
Tuesday 12
th
October - CONFERENCE DINNER (Smart Dress)
55.00
55.00
Tuesday 12
th
October - ACCOMMODATION B&B En Suite
85.00
85.00
Wednesday 13
th
October - CONFERENCE DELEGATE
145.00
180.00
TOTAL:
An invoice will be sent with all bookings.
If you would like us to quote a purchase order number, please enter it below.
Purchase Order Number
:
If you wish to pay by Credit Card, tick this box:
Data Protection Statement:
I understand that data supplied on this form will be used for the necessary purposes of running the conference.
In addition I agree to my data being used for the following: -
(i) inclusion in the delegate list and for conference related items
(ii) BCS, national and international initiatives in health informatics.
Please tick here to to enable your details to be used:
PLEASE NOTE THAT THIS BOOKING IS A CONTRACT. For cancellations received before 31
st
August 2010, fees will be refunded
subject to an administrative charge of £35.00.
Thereafter delegates are liable for the full booking fee but attendance may be substituted
at any time. All substitutions and cancellations must be notified in writing or by email to PHCSG Administrator (see the address details below).
Please tick here to agree:
X
PHCSG, 54 New Street, Worcester WR1 2DL
Tel: +44 (0)1905 727461
Email:
jill@phcsg.org
BCS VAT registration number: 618 1687 24
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