Eventmed UK Ltd

COURSE APPLICATION FORM

Print a copy of this form and send with your cheque (made payable to Eventmed UK Ltd) to:

Course Reservation, Eventmed UK Ltd

48 - 49 Broadgate, Preston, Lancashire PR1 8DU

Alternatively you can book by telephone using your credit card.

Course: ______________________________________

Venue: ______________________________________

Text Box: If you are attending the Pre-hospital Emergency Care Course please supply a passport style photograph Date: ________________________________________

Name: _______________________________________

Occupation: __________________________________

Contact Address: ______________________________

___________________________

Post code: ___________________

Telephone number: ___________________

Fax Number: _________________________

e-mail address: ________________________

Dietary requirements: __________________________________

Do you want us to reserve you accommodation?

How many nights?: __________

Which dates?: _______________________________________

Any special accommodation needs? ____________________

Please reserve me a place on the above course.

Have you enclosed your cheque ?- please don't forget the VAT!

Course fees are generally non-refundable unless the course is cancelled. Candidates may transfer to another available course at no extra charge. Courses involving outdoor exercises need suitable clothing. It is recommended that participants bring their own personal protective equipment as this is an ideal opportunity to test it’s effectiveness. A limited amount will be available for loan. Protective footwear will not be available & should be brought by participants, a minimum of steel toe-caps is required. Outdoor courses may also require a degree of physical fitness and the organisers will not be responsible for injuries incurred if a relevant disability is not declared.