Registration Form – Cheque and BACS payments only
Royal College of Psychiatrists
Advanced Communication Skills for Public Engagement
Royal College of Psychiatrists, HQ, London, UK
Tuesday2November 2017 /

PLEASE PRINT CLEARLY THIS INFORMATION WILL BE USED TO PRINT YOUR DELEGATE BADGE

A registration confirmation letter will be sent via email to the address you have provided on this form. If you are unsure if your registration form has been received by us contact

  1. Personal details (please complete in block capitals)

College membership number (if applicable):
Title:
/ First Name: / Surname:
Place of Work:
Mailing address:
Town:
/ Postcode: / Country:
Email:
/ Tel (Daytime):
Vegetarian: YES/NO
/ Special diets:
Special Requirements:
Career Status (tick one box only):
 MEDICAL STUDENT/STUDENT ASSOCIATE
 PMPT
 CT/ST1-3
 CT/ST4-ST6
 FY DOCTOR /  SHO
 ASSOCIATE SPECIALIST/STAFF GRADE/SpR
 RETIRED
 CONSULTANT
 OTHER (please state):
  1. Registration fees

Fees include catering during scheduled programme breaks but do not include accommodation.

Standard Rate
Fee / £195 
Total: / £
  1. Payment

Please note that the College is unable to invoice for registration fees.Places can only be reserved when payment is received with this form. If an authority is to pay, the delegate should either pay and then claim reimbursement from the authority or enclose payment from their authority.

□

Cheque:I enclose a cheque / postal order for £ ......

Please make payable to ‘The Royal College of Psychiatrists’ quoting reference ‘E2C0077300’ and the name of the delegate on reverse

□

BACS: I enclose remittance advice form for £ ......

Places can only be reserved when remittance is received with this form

When making payments please ensure a remittance advice is emailed to or faxed to the below number in order to ensure allocation. Please put the Delegate Name and‘E2C0107300’ as the reference to ensure payment is not delayed

Account name: The Royal College of Psychiatrists

Bank name: Barclays Bank

Bank address: 1 Churchill Place, London E14 5HP

Account number: 40201340

Sort Code: 20-06-05

IBAN: GB31 BARC 2006 0540 2013 40

Swift Code: BARCGB22

DATA PROTECTION STATEMENT

The College’s Data Protection Statement can be viewed at

CANCELLATION POLICY

(Notice must be given in writing by post or e-mail )

80% refund if written cancellation is received at least 4 weeks prior to the event

50% refund if written cancellation is received 2 weeks prior to the event

No refund will be given to cancellations received less than 2 weeks prior to the event

Should you be unable to attend, a substitute delegate is welcomed.

Please complete and return your registration form with your payment to:

Virali Shah

Centre for Advanced Learning and Conferences (CALC)

RCPsych

21 Prescot Street, London E1 8BB

Tel: 0203 701 2622

Fax: 0203 701 2761