Psych 1 Venue: The Abbey Hotel, Abbey Road, Great Malvern, Worcestershire, WR14 3ET Dates: Friday 6th to Saturday 7th March 2020
Click on the button to auto send the completed form to: info@cmhp.org.uk
Or post to Wendy Gundry, 23 Southway, Burgess Hill, West Sussex, RH15 9SY
Delegate Details - Information supplied on this form will be used by CMHP solely and will not be disseminated to third parties without prior consent.
Family Name:	First Name:
Job Title:	Title: Prof / Dr / Mr / Ms / Mrs / Miss
Employer:
Postal address:	Daytime telephone:
Email address: Please supply a second email address as email is the primary mode of contact prior to the course
Role: Please click as appropriate
Pharmacist	Pharmacy Technician	Nurse	Student	Other
Diet: Please click as appropriate
Halal	Kosher	Vegetarian	Vegan	Gluten free	Other
Accessibility: Please submit a description of any accessibility facilities required. While CMHP will make every effort to meet these needs, accommodations cannot be guaranteed without prior notification.
Registration details: You must be a paid-up member at time of booking AND attendance for member rate to apply. CMHP would encourage all delegates to attend as full two-day delegates to benefit from all aspects of the event and networking opportunities that take place.	MEMBER	NON- MEMBER
Two-day delegate fee – Includes: Friday – light refreshments, lunch and dinner + overnight accommodation Saturday - light refreshments, breakfast and lunch	£370	£470
Day delegate – Includes: Attendance, lunch and light refreshments. Cost is per day.	Friday	£150	£175
Saturday	£150	£175

PAYMENT INFORMATION - Please note; we will reserve a space, prior to payment, on receipt of a completed booking form. However, without a purchase order or invoicing details your booking cannot be completed and confirmed.
A. Payment by cheque: Cheques to be made payable to CMHP and must be in GBP (£) and should be sent on receipt of invoice
B. Payment by BACS CMHP: Sort Code: 40-35-34 Account No: 9272 2348
C. I require an invoice for payment THIS SECTION IS MUST BE COMPLETED AND CONTAIN A PURCHASE ORDER NUMBER Please liaise with your finance or procurement office to ensure you provide that department’s correct contact information.
Purchase Order Number
Finance Dept contact name:
Finance Dept Address:
Finance Dept Tel number:
Finance Dept contact email:
Cancellation Policy We regret that we must make a charge for cancelled registrations. If you notify us of the cancellation of your reserved place giving four weeks or more prior notice, 25% of the fee will be retained; four to two weeks prior notice, 50% will be retained; two and one weeks prior notice, 75% will be retained. There is no refund for non-attendance or cancellations made less than one week (7 days) prior to the event, whereupon the full fee will remain payable. CMHP reserves the right to cancel events and to return the registration fee. CMHP cannot be held responsible for any losses resulting from such cancellation, however caused. Every effort is made to ensure the final event contents match the advertised draft as far as possible. However, changes can be out of our control. No recompense will be made based on changes to the programme. I confirm that I have read and understood the above policy and wish to reserve a place at the event as detailed. Signed: Date:
How did you hear about this event?
CMHP website	CMHP mailing	CMHP discussion group
Event advertising flyer	email	CMHP Facebook
Twitter feed	Psych Bites	Journal / Other (please state)
Recommended by [please state at document foot]: a colleague / friend / manager / current CMHP member
Office use only	Financial hardship CMHP as a charitable organisation can provide a limited number of membership subscriptions or reduced event attendance fees for applicants with extreme financial hardship. To request a waiver of the application fee, contact info@cmhp.org.uk stating details of the financial hardship. Your request will be reviewed, and a determination will be made regarding payment of fees. CMHP, secures non-promotional, unrestricted educational grants from our corporate partners in order to support our educational activities. For more information on our Corporate Partnership Scheme please visit our website www.cmhp.org.uk. CMHP endeavours to work with the pharmaceutical industry to meet the ABPI's Code of Practice.
Registration No
Date Acknowledged
Invoice No
Date Sent
Payment received
Special requirements