PIIOS Distance Delivery: Registration

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Commissioning body details

Name of commissioning body (Trust)

Address

Contact name

Email address

Telephone number

Finance contact name

Finance contact email address

Finance contact phone number

How many places do you require?
We would require a minimum of 2 students to run the course, up to a maximum of 16

Estimated date of delivery
(Please allow at least 8 weeks’ lead time)

Delegate information

Please provide each of the delegates' names and their email addresses below

Delegate 1

First name

Surname

Email address

Delegate 2

First name

Surname

Email address

Delegate 3

First name

Surname

Email address

Delegate 4

First name

Surname

Email address

Delegate 5

First name

Surname

Email address

Delegate 6

First name

Surname

Email address

Delegate 7

First name

Surname

Email address

Delegate 8

First name

Surname

Email address

Delegate 9

First name

Surname

Email address

Delegate 10

First name

Surname

Email address

Delegate 11

First name

Surname

Email address

Delegate 12

First name

Surname

Email address

Delegate 13 (Optional)

First name

Surname

Email address

Delegate 14 (Optional)

First name

Surname

Email address

Delegate 15 (Optional)

First name

Surname

Email address

Delegate 16 (Optional)

First name

Surname

Email address

Payment

Please note that the minimum invoice will be for £5,400 for a cohort of 12 delegates and we are unable to offer refunds for students who have been registered but are not able to attend. Additional delegates will be charged at £450 each.

Purchase Order number

Full address of venue for course delivery

Privacy notice

How we use your data
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 Information Commissioner's Office's webpages for further information in relation to your rights and the University's webpages for further information about 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. 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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