CONFERENCE BOOKING FORM Your DetailsName First Last Job TitlePractice Name & AddressTelephoneEmail Booking DetailsPlease indicate which day(s) you would like to attendPlease indicate which day(s) you would like to attend* Two Day residential £325 (including Gala Dinner) Two Day non-residential £250 (excluding Gala Dinner) 26th September 2019 only £175 27th September 2019 only £175 Gala dinner if non-residential (Single ticket) £50 Please note any special dietary, access or other requirementsTotal £ 0.00 Payment MethodPayments by BACS should be made to the following account: Sort code: 20-50-21. Account Number: 33062910. Please put your name as remittance identification.Bookings must be confirmed by 31 July 2019 and full payment is in full within 28 days of booking Cancellations will not be refunded. For any queries please contact Rachael Bell on rachael.bell@nhs.netYour information will be passed to our sponsors. This will be limited to name and practice only. Telephone numbers and email addresses will not be passed on. Photos and videos will be taken of the event. CONFERENCE BOOKING FORM SPONSOR BOOKING FORM SPONSOR AGREEMENT FORM 2019 CONFERENCE VENUE SPEAKERS AGENDA PREVIOUS YEARS THE COMMITTEE CONTACT
