Leading Strategic Innovation in Healthcare - registration form

Please use this registration form to book your place on the Leading Strategic Innovation in Healthcare at Warwick Business School.

The WBS Executive Education team will contact you to discuss any further detail, and cover next steps on joining the programme.

Cohort (start date)

Personal Details

Title

Forename(s)

Family Name

Preferred name / nickname

Date of Birth (please use format dd/mm/yyyy)

Nationality

Country of Residence

Correspondence Details

Address 1

Address 2

Address 3

Address 4

Country

Zip/Post code

Telephone number

Confirm email address

Current Role & Responsibilities

Job Title

Company/Organisation

Your Funding / Sponsor An invoice will be raised to you/your organisation prior to the start of the programme, therefore we would require details on your method of funding. Once your place has been confirmed on the programme, you will be sent a further online form to collate your details for payment which can be completed by the participant, sponsor or finance team.

Self-funded

Sponsored by employer

Split funding

Disability

To enable us to provide appropriate support and guidance, please indicate which disability applies to you

Other, please specifiy

Ethnic Origin The University of Warwick is required to return statistics about the origin of all applicants to HESA, the United Kingdom national student data collection agency. Your co-operation in providing the following information would therefore be appreciated. All information provided will be treated confidentially.

Please indicate your ethnic origin:

What next? Once your application form has been received it will be forwarded to the Warwick Business School Executive Education team, who will confirm your place and share next steps. If you have any further questions about the programme and/or the admissions process, please contact WBS Executive Education at execed@wbs.ac.uk.

The information provided on this form will be used to register and administer your engagement with Warwick Business School, as an enrolled student/participant. When you submit this form we will add you to our Executive Education email mailing list. We will send you relevant information about application deadlines, forthcoming events and highlights of our programmes, as well as research and news from WBS. We will hold your information in accordance with our privacy policy http://www.wbs.ac.uk/privacy. You will, of course, be able to unsubscribe at any time by clicking the relevant link given in the footer of the emails we send.

Privacy notice

Please see above for details.

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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