MBChB Education Conference: Registration

Please complete the form below to request a place at the conference on Friday 19th May 2017. If you experience any problems with the form, please contact M dot A dot Stokes at warwick dot ac dot uk.

We will email you to confirm your place. Once the conference is fully booked, a waiting list will operate.

Medical students: Please note that you must have the usual required permission for absence from teaching to attend the conference.

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Title:

First name

Surname

Email:

Job title / MB ChB role:

Institution / workplace:

If you selected ‘other’, please specify your institution / workplace:

Staff: Please outline your MBChB role. Students: Please outline your aims in attending the conference.

Students only: Current Phase:

Please let us know if you have any special requirements, including dietary requirements, that we would need to take into account in the arrangement and delivery of this event:

Privacy notice

This form will be used to manage attendance at the MBChB Education Conference. Your attendance at the event and information you provide 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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