7th PCNE WORKING CONFERENCE, 23rd 26th March 2011

Registration Form

A. PERSONAL DETAILS*

Title: *
First Name: *
Last Name:
(Used in the production of badges)
*
Institution: *
Position:
Department: *
Address: *
Postcode/Zip: *
Country: *
Email: *
Telephone:
(+ international dialling code)
*
Mobile Telephone:
(+ international dialling code)
Fax:
Address for Correspondence:
(if different)
Please indicate any special requirements, e.g. diet, access etc:

B. REGISTRATION*

 

Before
28/1/2011

After
28/1/2011
Student Registration

£680

£730

Full Registration

£730

£780
(includes attendance at all sessions, refreshments, dinner on Wednesday and Thursday, bed and breakfast accommodation on Wednesday, Thursday and Friday and a memory stick with all conference materials).
 

C. EXTRAS

Conference Dinner on Friday at Quarry Bank Mill, Styal @ £49

Lunch on Wednesday (suggested for people who arrive early, or attend the PCNE General Assembly) @ £13.50

Lunch on Saturday (suggested for people who leave late, or attend the PCNE Working group meetings) @ £13.50

Bed and breakfast on Tuesday @ £55

Bed and breakfast on Saturday @ £55

D. ACCOMMODATION

Accommodation will be allocated in Chancellors Hotel and Conference Centre on a first come first served basis. Once full, additional bedrooms are available at the Willowbank Hotel (a short walk).

E. WORKSHOP OPTIONS*

Delegates should choose their first and second choice of workshop:

First Choice
Second Choice
Workshop Session
Facilitators
WS1: How to set up a research study Professor Carmel Hughes, UK & Dr. Nina Griese, Germany
WS2: How to develop/investigate individualised models of pharmaceutical care Professor Ines Krass, Australia & Dr. Charlotte Rossing, Denmark
WS3: How to measure individualised patient safety Professor Marcel Bouvy, Netherlands & Professor Kurt Hersberger, Switzerland
WS4: Feedback from patients as to individualisation of their care - CANCELLED Professor Katherine Payne, UK & Dr Sarah Wordsworth, UK
WS5: Integrating & using multidisciplinary patient records Ms Ann Slee, UK & Dr. Veerle Foulon, Belgium

F. PAYMENT*

Registration: £
Extras: £
Total Cost: £

 

Cancellation policy:- Cancellations received before 25th February will receive a full refund less a 50 admin charge. After this date, there will be no refund, but substitutions will be accepted if written notification is received.

Confirmation:- Booking requests will be confirmed only when forms AND payment have been received.

Data Protection:- Your contact details will appear on the conference participants’ list. If you do NOT wish your details to be included, then please tick the box

Please charge my credit/debit card:
I will send a cheque:
Please send me an invoice:
Please send me bank details to make a transfer
 
Card Type: *
Card Number: *
Expiry Date: *
Security Number:
(last 3 digits on the signature strip)
*
Issue Number/Start Date:
(Switch/Maestro only)
Cardholder's Name: *
Cardholder's House Number: *
Cardholder's Postcode: *
Please note that payment must be in Sterling (GBP)
Please make the cheque payable to The University of Manchester and send it to the address below.

Address to send invoice to: *
Order Number: *
VAT Registration Number *
Please confirm your email address so we can send you the bank details *

PCNE 2011
Confercare, STARS, The University of Manchester, Barnes Wallis Building, Oxford Road, Manchester, M13 0PL, UK
Tel: +44 (0)161 306 4089 | Fax: +44 (0)161 306 4070 | Email: mcc.reg@manchester.ac.uk