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Anticoagulation Management Theory & Practice Registration - 13th to 15th March 2018

Your Details:

Emergency Contact Details:


Details for Telephone Payments:
For telephone payments, please call Janice Denham in normal office hours on TEL: 02476 575758, with the following details to hand:

Full Name:
Course Name: Anticoagulation Management – Practice & Theory
Course payment reference: S.MRCT.0202
Amount – £1500
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Expiry Date:
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Details for Invoicing:
If you have selected to pay by invoice, please provide the details requested below. Invoices will be raised and sent directly to customers based on this information.

Data Protection Statement

I understand that:

The University of Warwick will use your personal data, including without limitation, name, address(es), email address, contact numbers, age, gender, date of birth, department, year of study, student status, type of course, department and details of my progress on my course (“Personal Information”) for the purpose(s) outlined in this notice and the University’s Data Protection Guidelines:

Your personal data will not be shared or disclosed to any third parties external to the University of Warwick.

By submitting this questionnaire you agree to your personal data being processed and used by the University of Warwick for the purposes outlined above and that the data will be held in perpetuity to maintain the integrity of The University’s Student and Academic Records.

For further information regarding: how your information is held, including how we maintain the security of your information, your rights to access information we hold about you, how to update us on any changes to your details or to withdraw your consent for your data to be used for the purposes outlines above then please contact:

For further information, please see:

Cancellation Policy

Cancellation policy: A delegate may withdraw from a CPD event 31 days or more before the start of the event without charge. If a delegate withdraws from a CPD event 30 days or less before the start of the event then they will be liable for 50% of the fee.


By ticking the box above I confirm that:

I have read and understood the Data Protection Statement and agree for the University to use my personal details

I confirm that, to the best of my knowledge, the information given in this form is correct and complete. I confirm that I am aware of the scale of the fees and charges on the due dates of payment as per the cancellation policy. I understand that should my sponsor at any time fail to pay my fees and charges that are due, I will be personally liable for them.

Note: A registration is not valid unless fees are paid or full details of sponsors are provided.

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