Leadership for GPs - Application form
Programme fee for 2014 is £2,500 + VAT
Please print clearly in black ink or type
Job title
Organisation
Work address
Post code
Tel
Practice Manager’s Name
Practice Manager Tel
Practice Manager Email
Home addressPost code
Tel
This application is confidential to Leadership for GPs Programme. Please use this application only and do not send any additional material.
Return to: Louisa Coulthurst -
The King’s Fund | 11–13 Cavendish Square | London W1G 0AN
Payment details (Tick one)
n I enclose a cheque for £ ______(+ VAT) payable to King’s Fund
n Please charge £ ______(+VAT) to my/my organisation’s credit card account (delete as appropriate)
Type of card ______(Note: we do not accept American Express)
Card #______Expiry date ______
Issue # (Switch/Maestro only) ______Valid from ______
n Please invoice me/my organisation (delete as appropriate)
Purchase order number (if applicable) ______
I understand that once this application is accepted, I/my organisation will become liable for the charges, including cancellation charges.
Name and address to which invoices should be sent
______
______
Phone ______Fax ______
Signed ______Date______
n I would like to receive regular email updates from The King’s Fund
Signature Date
Terms and Conditions:Bookings will be handled on a first come, first served basis.
Cancellation Policy:
All cancellations and substitutions should be confirmed in writing before the event.
Cancellation four weeks prior to commencement of the programme: 50 per cent of fee.
Cancellation two to three weeks prior to commencement of the programme: 75 per cent of fee.
Cancellation one week prior to commencement of the programme: 100 per cent of fee.
We are not able to make a refund for non-attendance.
The King's Fund reserves the right to cancel programmes at any stage and return any booking fee paid. In the event of cancellation, we will make all reasonable efforts to offer alternative development opportunities.
Payment:
All payment must be received by the course date or as per invoice terms.
Mastercard, Visa, Delta, Switch and Maestro are accepted.
The King’s Fund will invoice your organisation if you have requested it.
Please note that once the invoice is issued, you/your organisation will become liable for the charges, including cancellation charges.
I confirm that I have read and agree to the terms and conditions.
Signed: ______
Print name: ______ / Date: ______
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