Registration: Introduction to Clinical Ethics

{"elements":[{"isDiscrete":false,"hidden":false,"name":"1573806979456_0.9058050915326946_0.11821301636915771","readOnly":false,"id":507265016,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"Title","readOnly":false,"id":507265017,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"First name","readOnly":false,"id":507265018,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Surname","readOnly":false,"id":507265019,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Date of birth","readOnly":false,"id":507265020,"type":"dateTimeElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Male","value":"0-male"},{"text":"Female","value":"1-female"},{"text":"Other","value":"2-other"}],"name":"Gender ","readOnly":false,"id":507265021,"type":"radioElement"},{"isDiscrete":false,"hidden":false,"name":"Occupation","readOnly":false,"id":507265022,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Home address","readOnly":false,"id":507265023,"type":"textBoxElement"},{"isDiscrete":false,"hidden":false,"name":"Postcode","readOnly":false,"id":507265024,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Contact telephone number","readOnly":false,"id":507265025,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Email","readOnly":false,"id":507265026,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Disability you wish to disclose","readOnly":false,"id":507265028,"type":"textFieldElement"},{"isDiscrete":false,"hidden":true,"name":"Emergency contact name ","readOnly":false,"id":507265031,"type":"textFieldElement"},{"isDiscrete":false,"hidden":true,"name":"Relationship to you","readOnly":false,"id":507265032,"type":"textFieldElement"},{"isDiscrete":false,"hidden":true,"name":"Emergency contact number ","readOnly":false,"id":507265033,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"1573806979460_0.7104098606093898_0.31117321261060904","readOnly":false,"id":507265044,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"1739274316428_0.21686656045227093_0.6697515950430062","readOnly":false,"id":507265045,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"1573806979460_0.6166605614211947_0.6544568021326435","readOnly":false,"id":507265046,"type":"commentElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes","value":"0-yes"}],"name":"Receive info from Warwick","readOnly":false,"id":507265047,"type":"checkboxElement"},{"isDiscrete":false,"hidden":false,"name":"1573807241040_0.7508770996333207_0.1585631595272301","readOnly":false,"id":507265048,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"1573807250766_0.6947232752138993_0.9386313176892587","readOnly":false,"id":507265049,"type":"commentElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"I agree","value":"0-iagree"}],"name":"Declaration","readOnly":false,"id":507265050,"type":"checkboxElement"},{"isDiscrete":false,"hidden":false,"name":"1616675348095_0.6310230361443063_0.3168971639771171","readOnly":false,"id":507265051,"type":"commentElement"}]}

Your Details

Title

First name

Surname

Date of birth

Male

Female

Other

Occupation

Home address

Postcode

Contact telephone number

Email address

Disability you wish to disclose

Data protection

The University of Warwick will process your personal data for the purpose of registering you onto the PDC and online platforms.

The legal basis for processing this personal data is necessary for the performance of a contract

Your personal data will not be shared or disclosed to any third parties external to the University of Warwick. Your personal data be transferred outside of the EEA, will be kept securely by the University of Warwick and will be retained for

The University of Warwick is the Data Controller of this information and is committed to protecting the rights of individuals in line with Data Protection Legislation. Please visit the University’s https://warwick.ac.uk/services/idc/dataprotection/

Data protection webpages for further information in relation to your rights and how the University processes your personal data. The University’s Data Protection Officer can be contacted through DPO@warwick.ac.uk nfocompliance@warwick.ac.uk and any requests or complaints should be made in writing to the University’s Data Protection Officer.

Keeping in touch

Yes

Cancellation Policy

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

Declaration

I agree

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.

Privacy notice

We will use your personal data as described in our data privacy statement above.

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.

Spam prevention

Warwick Medical School