Registration

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Title

Full name

Affiliation

Email:

Please give details of any dietary requirements and/or allergies:

Contact Details

Address line 1

Address line 2

Town or city

County

Postcode

Country

Telephone

Data Protection

I agree

Cancellation Policy

If a delegate cancels his/her registration up to four weeks before the conference (15 September 2014), they will be entitled to an 80% refund of the fee paid. If a delegate cancels his/her registration less than four weeks before the conference, no refund will be given.

Payment

I agree

Privacy notice

This form will be used to manage attendance at an event. Your attendance at the event will be recorded and associated with your name, but no other personally identifiable data will be stored, and the data will not be used for any purpose other than as a record of the event.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

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Warwick Medical School

Registration

Contact Details

Data Protection

Cancellation Policy

Payment

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