Form

2nd Biennial Conference of the Association for Palliative Medicine of Great Britain and Ireland Including Annual General Meeting

23 - 24 April 2013, Aston Business School Conference Centre, Birmingham
Book your place before Monday 31 December 2012 and save £££'s
Title*
Forename*
Surname*
Job Title*
Organisation*
Contact phone number*
E-mail address*
Address for correspondance*
Dietary/other needs
Please indicate your membership status*

Member Non-member
Member Rates

Full Conference including accommodation - £370 2 day conference - £300
Non-Member Rates

Full Conference including accommodation - £390 2 day Conference - £350
Payment

Payment for the above selected Conference option is due in full prior to the event. Please click here to view the Cancellation Terms.

Joining Instructions will be issued to all delegates prior to the Conference, in April.

Please indicate below how you would like to make payment for your Conference place:
Payment options*

Please send me an invoice I will send a cheque payable to Association for Palliative Medicine I will make a BACs transfer Please contact me to take Credit/Debit card details
Please provide the address/e-mail address where you would like your invoice sent. Please also include a Purchase Order Number in this section (if applicable).
Cheque Payment

Please send your cheque made payable to 'Association for Palliative Medicine' to APM, 76 Botley Road, Park Gate

Southampton, SO31 1BA
BACS Payment

Association for Palliative Medicine Bank of Scotland Account:

Account number: 00145903

Sort Code: 12-09-61
Credit Card Payment

Please ensure that the contact number you have provided above is accurate as this is the number we will use to contact you.

Please note there is a 3% fee for all credit card transactions. There is no fee for debit card transactions

'Everyevent' will appear on your credit/debit card statement
Should be Empty:

2nd Biennial Conference of the Association for Palliative Medicine of Great Britain and Ireland Including Annual General Meeting