Group Registration

Title

Full name

Affiliation

Contact number

Billing Details

Name of Institution (for billing purposes)

Address line 1

Address line 2

Town or city

County

Postcode

Country

The contact details below will be used if an invoice needs to be chased. You may wish to give contact details for your finance team.

Telephone (if different from the one given above)

Email address (if different from the one given above)

Fax

Registration Options

Number of Attendees

Please provide the full name of each attendee as well as a valid email address.
The email is required to send details of how to access to the course.

Data Protection

I agree

Terms and Conditions

I agree

Payment Details

Following submission of this form, you will receive an invoice for course fees to cover all attendees (£150 per attendee). Please see the Terms and Conditions above for current cancellation charges.

Privacy notice

This form will be used to manage attendance on the Infant Mental Health Online course. Please see the above data protection statement for full details of how your personal details will be used.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

Spam prevention

Warwick Medical School