Booking Form

Event Details

Event Title [Required]

Reference [Required]

Start Date (dd-mm-yyyy) [Required]

Event Details 2

Event Title [Required]

Reference [Required]

Start Date [Required]

Event Details 3

Event Title [Required]

Reference [Required]

Start Date [Required]

Applicant Details

Title [Required]

Other title

Surname [Required]

Forenames [Required]

Date of birth (dd-mm-yyyy) [The DOB data will only be used as a unique identifier]

Job Title [Required]

Rank [Required]

Organisation [Required]

Organisation Function/Type [Required]

Address [Required]

Postcode [Required]

Telephone [Required]

Fax

E-Mail [Required]

Please complete if you are outside of the EU:

Nationality

Passport No.

UK Visa No.

5% discount to members of the Emergency Planning Society.
Please claim your discount at the time of booking by providing a valid membership number. Please note: we are unable to apply the discount retrospectively. We will also verify your membership to ensure it is current prior to confirmation.

Membership No

Invoice Information

Is this written confirmation of an earlier telephone booking? [Required]

YesNo

PO Ref: (this will be quoted on your invoice)

I confirm that payment for this booking has been fully authorised by the budget holder [Required]

Budget Holder Name

Email

Telephone

Invoice details if different to the above:

Name

Department

Organisation

Address

Postcode

Telephone

Fax

E-Mail

Marketing Information

Where did you hear about this event?

Other

Other Information

Preferred method of correspondence

Email
Mail

I have read and agree to the terms and conditions [Required]

I have read and agree to the attendance policy [MSc EPM students are exempt from the attendance policy]. [Required]

The Emergency Planning College will retain information from this booking form in accordance with the Data Protection Act 1998. If you want your details to be excluded, please tick the box.

Confirmation of this booking will be sent within seven days.

If you experience any difficulty with making a booking or would like to clarify your booking form has been received, please contact Reservations on:

Telephone: +44 (0)1347 822 877
Fax: +44 (0)1347 822 575

e-mail: epc.reservations@cabinet-office.x.gsi.gov.uk

Emergency Planning College

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