Registration for Advanced Ethics Training 22nd and 23rd June 2022

{"elements":[{"isDiscrete":false,"hidden":false,"name":"1565864287747_0.18098886169446715_0.10500926034972113","readOnly":false,"id":499439376,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"Title","readOnly":false,"id":499439377,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"First Name","readOnly":false,"id":499439378,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Surname","readOnly":false,"id":499439379,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"DOB","readOnly":false,"id":499439380,"type":"dateTimeElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Male","value":"0-male"},{"text":"Female","value":"1-female"}],"name":"Gender","readOnly":false,"id":499439381,"type":"radioElement"},{"isDiscrete":false,"hidden":false,"name":"Occupation","readOnly":false,"id":499439382,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Home Address","readOnly":false,"id":499439383,"type":"textBoxElement"},{"isDiscrete":false,"hidden":false,"name":"Postcode","readOnly":false,"id":499439384,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Telephone","readOnly":false,"id":499439385,"type":"phoneNumber"},{"isDiscrete":false,"hidden":false,"name":"Email","readOnly":false,"id":499439386,"type":"emailElement"},{"isDiscrete":false,"hidden":false,"name":"disability details","readOnly":false,"id":499439388,"type":"textBoxElement"},{"isDiscrete":false,"hidden":false,"name":"Clinical Ethics committee name","readOnly":false,"id":499439391,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Teams name","readOnly":false,"id":499439392,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"1647355312662_0.28908641227650744_0.8439878949107987","readOnly":false,"id":499439411,"type":"commentElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes","value":"0-yes"}],"name":"Receive info from Warwick","readOnly":false,"id":553275144,"type":"checkboxElement"},{"isDiscrete":false,"hidden":false,"name":"1646735850480_0.5103989487704458_0.8761907951643962","readOnly":false,"id":499439404,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"1647520174447_0.06291865972338528_0.7253177397232152","readOnly":false,"id":499439405,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"1565864287750_0.1670249064791598_0.7716238970834632","readOnly":false,"id":499439406,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"1565864287750_0.3944891504052749_0.5492130404062224","readOnly":false,"id":499439407,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"1565864287750_0.7229748225160142_0.5790963814401879","readOnly":false,"id":499439408,"type":"commentElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"I agree","value":"0-iagree"}],"name":"Declaration","readOnly":false,"id":499439409,"type":"checkboxElement"},{"isDiscrete":false,"hidden":false,"name":"1565864287751_0.1488767567934829_0.4724658087175325","readOnly":false,"id":499439410,"type":"commentElement"}]}

Your Details:

Title

First name

Surname

Date of birth

Male

Female

Other

Occupation

Home address

Postcode

Contact telephone no.

Email address

Disability you wish to disclose

Name of your Clinical Ethics Committee (if you have one)

Preferred name by which you would like to be known on Teams (e.g. full name or first name only)

Keeping in touch

Yes

Data Protection

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 will not be transferred outside of the EEA, will be kept securely by the University of Warwick and will be retained for 1 year

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 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 infocompliance@warwick.ac.uk and any requests or complaints should be made in writing to the University’s Data Protection Officer.

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. Please submit any data subject rights requests to infocompliance@warwick.ac.uk or address any complaints or suspected breaches to the University’s Data Protection Officer at DPO@warwick.ac.uk.

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.

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

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.

Spam prevention

Warwick Medical School