Autumn Forum Registration Page

If you have any problems submitting this page please contact Pelican Event Registration Services on 01932 849290. The office is open from 08:30 - 16:30 Monday - Friday.

* Title: Fields marked * must be completed prior to submitting the form
* First Name:
* Surname:
* Job Title:
Organisation - line 1:
Organisation - line 2:  
Department:  
* Address - line 1:  
Address - line 2:  
* Town:  
County:  
Postcode: -  
Country:  
* Telephone: # # Please type numbers only. Please do not use any spaces, hyphens, etc.
Mobile Phone: #
Fax: #
* Email Address:  

Payment Details

Fees

The fee is £350.64 + VAT (total £412.00) per participant.

There is a reduced rate of £315.74 + VAT (total £371.00) for additional participants from the same organisation, booking at the same time, with all the fees included as one payment.

The student rate is £85.11 + VAT (total £100.00).

Payment may also be made in Euros, please contact Pelican Services.

Morning coffee, lunch and afternoon tea are included plus the Conference information pack.

Please select your payment method

a Please send an invoice. Purchase order number
b

Payment will be made by BACS.
 

Sort code: 16-57-10. Account number: 49319279

c

I will send a cheque.

 

Cheques should be paid in sterling and drawn on a UK bank. Euro cheques are also accepted.
Cheques should be made payable to BJHC Limited and sent to: Pelican Services Events Department, 45 Woodland Grove, Weybridge, Surrey, KT13 9EQ, GB

d

I will pay by credit card.
 

To pay by credit card please send a fax to Events Department: +44 (0)1932 830227 with:

  • your card number
  • the expiry date and, if paying by Switch, the issue number
  • your name as it appears on the card
  • card billing address
  • your signature

Other information

Multiple Bookings This is one of from
Special Requirements
CPD Credits I intend to apply for CPD credits
Non-UK VAT

Your VAT number
Our VAT number is GB 413 5110 08. A VAT receipt will be sent with your confirmation. VAT will be applied at the prevailing rate, currently 17.5%.

Notes

Cancellations and substitutions: cancellations will only be accepted in writing. Full refunds, less a 20% administration fee, will be given on cancellations made up to 20th October 2005. Thereafter the full fee is payable. Substitutions can be made at any time.
Disclaimer: if any of the advertised speakers are unable to attend the conference, the organisers reserve the right, without prior notice, to make alterations and substitutions to the programme. Participants will have no claim against BJHC Limited.
Payment: all fees must be paid before the conference.

Data Consent Statement

By submitting this form I consent to the use of my personal data by BJHC Limited for the core purpose of running this conference
In addition (please tick as appropriate)
* I wish to continue to receive information from BJHC Limited about its heathcare informatics events and publications:

by email by post/fax

* I wish to continue to receive information about heathcare informatics products, services, events and publications from others through BJHC's database:

by email by post/fax

I have read and understood the above data consent statement. Please type any letter if you agree *