ICHNNR booking form

Conference

Transforming Community Health: the nursing impact

Edinburgh • 13th and 14th March 2013

Please complete a form for each delegate attending

How to book:

Either fill in and print off this form and post it to us, at the address below, with your payment
or complete and submit the form
Please note: if you are paying on-line, you will need to make the payment and then return to submit the form

*required fields

Your Details

Title

*Institution/
Organisation

*Prenames

*Telephone

*Surname

Mobile

*Contact
address

Fax

*Country

Postcode

*Email

Special requirements (e.g. mobility, diet, vision, hearing etc.)

*Where did you hear about this event?

Email notification
From a colleague
Media (please specify)

Would you be interested in attending CPHVA New Researchers Doctoral Masterclass? yes no

Have you submitted an abstract for either an oral or poster presentation? yes no

Interested in becoming a member of ICCHNR? Click here for details

Conference options

Conference Fee

Conference Package includes: • Attendance at the conference • All tea/coffee breaks in the programme • Lunch on Wednesday and Thursday • Conference Dinner on Wednesday evening
Early bird conference fee: available until 1st October 2012	£200
ICHNNR member conference fee	£175
QNIS member conference fee: available until 1st October 2012	£125
PhD students – reduced conference fee	£100

Payment options

Please confirm that you have read and agree to the terms and conditions of booking

I enclose payment (cheques made payable to The University of Edinburgh)

Please invoice me (please note with this option a £5 administration fee will be charged)

I am paying on-line

Click here to pay online, then return to submit form

For postal bookings please send the form plus payment to: Laura Marshall, ICHNNR conference,
CRFR, University of Edinburgh, 23 Buccleuch Place, Edinburgh, EH8 9LN