Royal College of Psychiatrists

West Midlands Division Winter Meeting

Friday, 25 November 2016

Village Hotel, Solihull B90 4GW

Registration Form

PLEASE PRINT ALL DETAILS CLEARLY

Please tick here if you do not wish to have your name and place of work or town appearing on the delegate list.

The College’s Data Protection Statement can be viewed at

  1. Personal details

College membership number:
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.

Whole Conference
Standard Delegate Rate / £80
Trainee Rate / £50
Retired Rate / £50
Invited Complimentary / £0 

All registration confirmation letters will be sent via email.

Any queries please contact Gloria Zachariou at the West Midlands division office.

Please read and complete details overleaf…

  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 ‘Royal College of Psychiatrists’ stating name of delegate on reverse.

Credit/debit card: If you wish to pay by card, please do so online as we are unable to take credit/debit card details via hard copy.

Please note that you can book online at:

CANCELLATION POLICY

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 for cancellations received within 2 weeks of the event.

If you are unable to attend, a substitute delegate may attend in your place.

CANCELLATION BY RCPSYCH

RCPsych reserves the right to amend or cancel an event. If an event has to be cancelled or date amendment made we will contact all registered delegates as soon as possible to notify them of the change. All delegates will be offered an alternative date or a full refund. We are not able to reimburse travel, accommodation or other costs related to the event.

RCPsych shall assume no liability if an event is cancelled, rescheduled or postponed due to a Force Majeure such as fire, strike, industrial action, extreme weather or any cause beyond our control.

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

Gloria Zachariou

Royal College of Psychiatrists

Vancouver House

111 Hagley Road
Edgbaston, Birmingham B16 8LB

: 0121 452 5120  0121 452 5121