EmailMeForm
UKCPA Masterclass Registration Form
You should use this form to register for UKCPA masterclasses. Please do not use it to register for other events.
Membership status
*
UKCPA member
Non member
Membership application to follow
Applications not received within 7 days will be charged at the non members rate. Please refer to: http://www.ukclinicalpharmacy.org/join/how-to-join/ for all joining information and forms
Membership number
If you are joining as a member at the same time as registering for this event, and taking advantage of the special UKCPA members rate, please state 'membership applied for'
Title
Mr
Mrs
Miss
Dr
Prof
Other, please state
Name
*
First
Last
Email address
Please do not specify a Hotmail account.
*
We will use this email address to contact you about this event.
Please confirm your primary email address or enter a different address you can be reached on
*
Please do not specify a Hotmail account.
Please confirm you have not specified a Hotmail email address
*
I confirm I have not specified a Hotmail email address
Registration forms containing hotmail addresses will be rejected.
Address for correspondence
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Phone
*
Place of work
*
Please write your place of work in full, as you would like it to appear on the delegate list
Branch
Hospital
Community
Prescribing Advisor
Industry
Academic
Other, please state
Please confirm which sector(s) you work within
Event title
*
Group running event and date
*
Please select
WAITING LIST: Critical Care (SOICC), 04 12 20
If the group event you wish to attend is not here, it means the event has reached maximum capacity and is no longer taking bookings.
Venue/Location of event
Event delegate list.
*
I am happy to appear on the delegate list
I do not wish to be included on the delegate list
The UKCPA prepares and distributes a delegate list at all masterclasses for both attendees and, if applicable, sponsors/exhibitors. Details included on the list are your full name and place of work only. Please check the appropriate box above to be included.
Dietary requirements
ie, vegetarian, vegan, halal, kosher, or any allergies
Special needs
ie, wheelchair access, hearing loop
Payment Options
*
I require your bank details so I can make a direct credit transfer from my personal account. I will make payment within 7 days
I wish to pay over the phone by Debit/Credit card. I will call the UKCPA office within 7 days
Pre agreed NHS Trust Educational Credit Scheme
As from 31 March 2020 we no longer accept purchase orders or issue invoices for individual event registrations.
Pre agreed NHS Trust Educational Credit Scheme
Please enter your redemption code here
Do you require a receipt?
Yes
No
Receipts will be sent to the email address given above. Receipts will only be issued when full payment has been made and cleared to the UKCPA bank account.
UKCPA’s Cancellation Policy. Please select 'Yes' to confirm that you have read and understood this policy.
*
Please select
Yes
We regret that we have to make a charge for cancelled registrations. If you notify us of the cancellation of your reserved place giving six weeks or more prior notice to the event, 25% of the fee will be retained. From six to 3 weeks prior to the event, 50% will be retained. If between three and one week’s notice is given of the cancellation for your reserved place for a UKCPA event, 75% will be retained. There is no refund for non-attendance or cancellations made less than one week (7 days) prior to the event, whereupon the full fee will remain payable. The Association reserves the right to cancel meetings and to return the registration fee. The Association cannot be responsible for any losses resulting from such cancellation, however caused.
How did you hear about this event?
UKCPA website
UKCPA discussion board notice
Rx Magazine
Event advertising flyer
UKCPA Facebook
UKCPA Twitter
third party organisation
Journal, ie Pharmacy Magazine, Pharmaceutical Journal
Recommended by a colleague, friend or manager
Other; please state
Please check all that apply
Confirm registration
*
I understand
By clicking on the submit button, you are confirming that you wish to reserve a place at the masterclass as specified above and will be bound by our terms and conditions.