NHS staff booking form

Please fill out this form you wish to book for an event and are unable to pay by credit card.

Event title*
Event date*
Name of person booking*
First Last
Job title
Email address*
Organisation and address*
Contact phone number
Name of delegate (if different from above)
First Last
Email address of delegate (if different from above)
Specific dietary requirements
Any other requirements/comments
Payment information
We are unable to refund fees once a place is confirmed, unless we can fill the cancelled place from a waiting list. Payment is required in advance.
You can read our event terms and conditions by clicking the link below:
https://www.martlets.org.uk/education-and-training-event-terms-and-conditions/
I am NHS staff and the purchase order for this booking is*
The invoice should be sent to (if different from above)
Privacy
Your personal data will be used by Martlets for the purpose of delivering this course or event, and for statistical purposes only.
Please tick the box below if you would like to be kept informed of future courses, events and education resources
- Yes
Martlets full privacy statement can be found at:
https://www.martlets.org.uk/privacy-statement
Email
This field is for validation purposes and should be left unchanged.

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