THURSDAY12MAY 2016
WELLCOME GENOME CAMPUS
CONFERENCE CENTRE
HINXTON
CAMBRIDGE, CB10 1RQ
College Membership Number or Date of Birth: / Title:
First Name: / Surname:
Place of Work:
Specialty:
Mailing Address:
(if paying by credit card must be same as billing address)
County: / Postcode:
Tel (daytime): / Dietary Requirements
Email: / Special Requirements (e.g. mobility needs etc)
Please contact the Division Office
INDICATE APPROPRIATE CATEGORY
Non Member / £200.00 /
Consultant/Locum Consultant / £170.00 /
Specialty Doctors, ST4 – ST6 / £140.00 /
CT1/2/3 (PMPT+),Retired Member / £100.00 /
Non Medical Colleagues / £70.00 /
Medical Students, Foundation Year Doctors
Medical students and FY doctors can get free entry through ‘Enhancing Foundation Experience in Psychiatry’ Initiative of HEEoE School of Psychiatry
Please email Dr Abu Abraham:
I ENCLOSE A CHEQUE FOR £______(made payable to ‘The Royal College of Psychiatrists’ quoting reference J1H0017300 and name of delegate if sent by Trust)’
DATAPROTECTIONSTATEMENT
The College’s DataProtectionStatementcan be viewed at
Please complete andreturn your registration formwith yourpayment by:
Monday9MAY2016 TO:
Moinul Mannan, Eastern DivisionCoordinator
TheRoyalCollegeof Psychiatrists,Professional Standards
3rdFloor, 21 Prescot Street,LondonE18BB
T: 0203701 2590 E:
CANCELLATIONPOLICY
80% refund if notice is received 1 month before the event
50% refund if notice is received 2 weeks before the event
No refund will be given to cancellations received after 4 March 2016
Should you be unable to attend, a substitute delegate may attend in your place
PAYMENTMETHOD
Places canonlybe reserved when payment is receivedwith this form
THE COLLEGE IS UNABLETO INVOICEFOR REGISTRATION FEES
If an authority is topay,the delegateshouldeither pay andthen claim reimbursementfromthe authority orenclose payment fromtheir authority.