Maudsley Prescribing Guidelines Conference – Registration Form

Tuesday 3rd July 2012, B5 Auditorium, Kings’ College, London

Your details (please complete a new form for each delegate)
Payment by cheque or BACs with registration form by post to be received by FRIDAY 22ND JUNE 2012
Electronic paymentvia to be received by WEDNESDAY 27th JUNE 2012
(Registrationprocess via KCL E-storewill substitute the booking form)
Delegates who wish to attend the conference after the closing date WEDNESDAY 27TH JUNE 2012 should contact the Event Organiser (details on page 2). This will be subject to the discretion of the Event Manager.
Prof / Dr / Mr / Mrs / Ms / Other (Please circle)
First name
Surname
Job Title
Department
Organisation
Address
Post Code
Telephone / Work / Mobile
Email (preferred address)
Please write your address clearly as an e-ticket will be sent by e-mail as confirmation of place
Please also ensure you complete your full postal address details for our records
Please specify any special dietary or access requirements
This form must be signed by the delegate or an authorised person before we can accept the booking
(by signing this form, you are accepting the terms and conditions on page 2)
Name
Signature(electronic signatures are accepted)
Date
Venue
B5 Auditorium
FranklinWilkinsBuilding, Waterloo Campus, Stamford Street, London, SE1 8WA / Conference fee includes
Entrance to conference, programme, lunch and refreshments on the day
Date
Tuesday 3rd July 2012 / Confirmation of booking
All bookings will be confirmed by email. Please contact us if you have not received confirmation 5-7 days after submitting your booking form
Conference fee
£150.00 / Travel details
A map and travel details will be sent with your booking
PaymentDetails
By debit/credit card (VISA/VISA debit/VISA Electron/Mastercard/Maestro
The easiest way to book is via KCL e-store.
To access the e-store, either select then “conferences and seminars”, “conferences”
By cheque
Please make cheques payable to KING’S COLLEGE LONDON.
Cheques must be paid in UKSterling (£). Please ensure the cheque(s) are completed correctly, checking they are signed, dated appropriately and that the words and figures agree with each other.
By BACs
Beneficiary Account Name: King's College London
Bank Sort-Code: 56-00-13
Bank Account Number: 96-70-74-02
KCL Account to be credited: JGA9304
Please send your BACs remittance or email advice as confirmation of payment.
Your BACs reference
How did you hear about this event?
Advert in British Journal of Psychiatry / Through the KCL e-store, London
Advert in The Psychiatrist / Institute of Pharmaceutical Science website
SLaM website / Through King’s email
SLaM News / Word of mouth
CMHP website/email
Terms and Conditions
  1. Returning the signed registration form constitutes a firm booking
  2. King’sreserves the right to cancel a booking if payment is not made fourweeks prior to the conference taking place. Any outstanding payment becomes the responsibility of the signatory made on the registration form
  3. Written cancellations received six weeks (Tuesday 29th May 2012) prior to the conference will be accepted and a refund less a £75 administration fee will be made. After this date, no refunds can be given. Verbal cancellations will not be accepted. If written cancellation is not received six weeks prior to the conference, full payment will still be due irrespective of whether the delegate attends the conference. Substitute delegates are welcome at any time.
  4. King’s reserves the right to make changes to the speakers and programme without prior notice. Speakers approved at time of print.

Please send completed registration forms and cheques to:
Miss Maria O’Hagan, Research and Events Co-ordinator/EA to Professor David Taylor,
Pharmacy Department, MaudsleyHospital, London, SE5 8AZ
Please email or fax completed registration forms to:
Telephone: 020 3228 5353 Fax: 020 3228 5279 Email: