WINTER CONFERENCE 2017 REGISTRATION FORM

Conference rates are based on attendance i.e. for 1 day (either Thursday or Friday) or 2 days (Thursday and Friday) and on being a College Member or Non-Member. The rates include lunch and access to all meetings / speakers.

Name ______Membership Number ______

Correspondence Address______Email ______

Early Bird
Members
Until 5pm on
19th Oct
2017 / Standard
Member / NCHD/Intern/
Retired***
Member / Poster Presenter- Member / Non Member Rates
Thursday 16thonly
7.5 External CPD Credits
Please tick relevant box / €150.00 / €170.00 / €60.00 / €50.00 / €315.00
Friday 17th only
6 External CPD Credits
Please tick relevant box / €150.00 / €170.00 / €60.00 / €50.00 / €270.00
2 Days
Thurs 16thand
Friday 17th
Please tick relevant box / €280.00 / €320.00 / €110.00 / €95.00 / €550.00

*** Doctors participating in a PCS scheme are not eligible for retirement rate

Conference Dinner
From 7.30 pm Thursday16thNovember (please statedietary requirements) / Members &
Non- Members
€60.00 / Please tick box

Please debit the following amount from my account (Please note that all card payments will be processed in euros)

€ _ _ _ _ _ * Card Number______Expiry Date _ _ / _ _

Security Code: _ _ _ VISA MASTERCARD DEBIT CARD

Or

I enclose a cheque made payable to the College of Psychiatrists of Ireland for€______*

*No refund will be given for bookings cancelled after Thursday2nd Nov2017

Please refer to the programme and choose two sessions for Thursday afternoon

I wish to attend:

W2017.1 OR W2017.2 OR W2017.3 (Please select one only)

W2017.4 OR W2017.5 OR W2017.6 (Please select one only)

Numbers may be limited in a session. It may not be possible for all delegates to attend their first choice

Email: / FAX TO 01 – 6854291