Please fully complete and submit this form to register your interest. (*) = required field.

Preferred Salutation:
MrMsMrsMissDrProfessor
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Your full name: (*)

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Position: (*)

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Organisation:

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Address: (*)

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Postcode: (*)

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E-mail: (*)

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Telephone: (*)

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Attendance Options: (select one)

Public Sector: £25
Private Sector: £35

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Payment Option (*)
Cheque payable to Leeds UniversityPurchase OrderCredit/Debit CardPlease invoice my Organisation
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Online payment can be made here (opens a new window - navigates away from this site)

Please note that registrations received without a supporting Purchase Order document cannot be processed. The conference fee is exempt from VAT and payment can be made by Bank Transfer, Credit Card or Cheque made payable to the ‘University of Leeds’. Please note, due to University policy, we can only accept credit/debit card details for payments over the telephone. Unfortunately we are unable to accept payment by American Express. Terms of payment are 30 days from date of invoice. Conference Fees must be paid in full no later than 20 working days before the conference commences.

Registrations are accepted on the understanding that the printed programme is given in good faith but may have to be re-scheduled or the speakers changed for reasons outside our control. The University of Leeds reserves the right to cancel or postpone the conference, in which case fees will be refunded in full. In the event of cancellation, The University will not be held liable for delegates travel or accommodation expenses. Where a delegate wishes to cancel a registration, written cancellations received up to 20 working days before the conference will be subject to an administrative charge of 20% of the total remittance. After this date the full fee is chargeable and no refunds will be made, this also applies for nonattendance but copies of the conference material will be sent. Substitutions may be made at any time. Payment should accompany your registration, unless you have requested an invoice to be sent to you.

For Further Information please contact

Z.Qadri
CPD4 Health Innovation
Enterprise and Innovation Office
Charles Thackrah Building
University of Leeds
101 Clarendon Road
Leeds LS2 9LJ
Email: z.qadri@leeds.ac.uk

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