Module Booking Form
Please indicate which module you wish to commence by ticking the relevant box and inserting your chosen ‘Start Date’.
Please see the current timetable for a list of modules beginning each semester.
Code / Module Title / Start Date (Month/Year) / FCP* / ELP* / AO* / Total
A-FAVP.1 / Foundations in Advanced Veterinary Practice / £995 / £700 / £550
B-SAP.1 / Small Animal Practice / £900 / £700 / £550
C-SAM.4 / Feline Medicine A / - / £700 / £550
C-SAM.5 / Feline Medicine B / - / £700 / £550
C-SAM.6 / Feline Medicine C / - / £700 / £550
C-SAM.8 / Small Animal Medicine A / £900 / £700 / £550
C-SAM.9 / Small Animal Medicine B / £900 / £700 / £550
C-SAM.10 / Small Animal Medicine C / £900 / £700 / £550
C-SAS.1 / Small Animal Surgery Core / - / £700 / £550
C-SAS.2 / Small Animal Soft Tissue Surgery A / £900 / £700 / £550
C-SAS.3 / Small Animal Soft Tissue Surgery B / £900 / £700 / £550
C-SAS.6 / Small Animal Orthopaedic Surgery A / £900 / £700 / £550
C-SAS.7 / Small Animal Orthopaedic Surgery B / - / £700 / £550
C-VD.1 / Veterinary Dermatology Core / - / £700 / £550
C-VD.2 / Small Animal Dermatology A / £900 / £700 / £550
C-VD.3 / Small Animal Dermatology B / - / £700 / £550
C-VA.1 / Small Animal Anaesthesia & Analgesia / - / £700 / £550
C-VA.3 / Critical Care & Analgesia / £900 / £700 / £550
C-ECC.2 / Emergency Care A / £900 / £700 / £550
C-ECC.3 / Emergency Care B / £900 / £700 / £550
C-VDI.1 / Imaging in Practice / £900 / £700 / £550
C-VDI.2 / Small Animal Diagnostic Imaging: Orthopaedics / £900 / £700 / £550
C-VDI.3 / Small Animal Diagnostic Imaging: Soft Tissue / £900 / £700 / £550
C-VC.1 / Cardiovascular Anatomy, Physiology & Pathology / - / £700 / £550
C-VC.2 / Cardiovascular Diagnostics / £900 / £700 / £550
C-VC.3 / Cardiovascular Therapeutics / - / £700 / £550
C-EBVM / Evidence Based Veterinary Medicine / - / £550 / -
C-VPC.1 / Clinical Audit / - / £550 / -
*FCP = Full Course Participant (includes a workshop) / ELP = eLearning Participant / AO = Assessment Only / Total Due / £
Forename(s): / Surname:
Address:
Post Code: / E-mail: / Tel:
If any of the details in this section are different to those you originally registered with, please tick this box o
FURTHER INFORMATION
Have you already completed a module with the University of Liverpool? / o Mini-module(s) / o CertAVP/VBM
If yes, please include your student ID number:
If yes, please include your date of birth:
Please tick all that apply:
I have enrolled for the CertAVP with the RCVS / I am a member of the RCVS
I have already completed the A-FAVP.1 module / NEW STUDENTS ONLY
I have enclosed a completed Student Registration Form
I have already completed the B-SAP.1 module / Student Registration Forms can be found online at www.liv.ac.uk/cpdvets or by emailing
Where did you hear about us?
PAYMENT DETAILS
Payment by Cheque
Please make cheques payable to: The University of Liverpool / Cheque enclosed: / £
Payment by Credit/Debit Card
If you would like to pay by credit/debit card please return your completed booking form and we will send you an email with directions to a secure website within the University system where you will be able to complete your payment.
Alternatively, we can accept card details by phone, and a member of the team will call you to take your card details.
Please indicate which method you would prefer:
Online
(Contact details) / Telephone (Contact details)
We are unable to issue invoices for payment. We cannot accept payment by bank transfer / BACS.
It is understood that payment for modules can, in some circumstances, take time to process. For this reason we accept module bookings on the understanding that payment will be received and processed prior to the module commencement date. Delegates who withdraw after the module commencement date are liable to pay the module fees in full regardless of whether the payment has been received or whether they have accessed the module.
Please ensure that we receive your booking form by the appropriate enrolment closing date:
30 November 2017
for
January 2018 / 29 March 2018
for
April 2018 / 19 July 2018
for
August 2018
BOOKINGS RECEIVED AFTER THE CLOSING DATE WILL NOT BE ACCEPTED
Please return your completed form by email, fax or post to:
Veterinary Postgraduate Unit, University of Liverpool, Faculty of Veterinary Science,
Leahurst, Neston, Wirral, CH64 7TE
Tel: / (0151) 794 6016 / Fax: (0151) 795 6099 / Email: /
FOR OFFICE USE ONLY
Date received:
Cheque / Issued by: / Amount:
Reference Number:
Online Store / Link: / Date & Initial / Telephone / Conf.: / Date & Initial
Receipt / Date & Initial
Every year the University will send some information we hold about you to HESA (“your HESA information”). HESA is the official agency for the collection, analysis and dissemination of quantitative information about higher education (HE) in the UK. Your HESA information is used for a variety of purposes by HESA and by third parties. Information provided to HESA is retained indefinitely for statistical research purposes. You can find out more at https://www.hesa.ac.uk/about/regulation/data-protection/notices
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