RDS SE Event Booking Form - Surrey

We will need all the information requested below in order to process your form.
Please ensure you complete all sections. Fields marked * are mandatory.

Date:
Title:
*Name:
*NHS Trust/Organisation:
*Address Line 1:
Address Line 2:
Address Line 3:
Town / City:
County:
Postcode:
*Phone Number:
*Email address:
*Please add me to the RDS SE mailing list:
*Job Title:
I would like to attend: *Session title:

*Location:

*Date:
Where did you hear about the event/course?

The Department/I agree to pay the sum of £100 in the case of non-attendance or cancellation received with less than 24 hours notice
*Please tick this box to confirm you understand the above

The RDS SE complies fully with the Data Protection Act 1998. Personal data will be stored confidentially and will not be disclosed to any third party (any organisation outside the RDS SE) by RDS SE staff, except where individual consent has been sought and granted.