Regional CPD Event Form

Region from Dropdown *

Your Position in the Region

Your Name *

First

Last

Email *

Event Type *

Event Date

Event Arrival Time

Event Start Time

Event End Time

Event Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Please complete as new members might not know the college or venue.

Event Description *

Add any presenters, subjects or other details that are likely to encourage members to book.

On the day information telephone number

Any other information you would like on the invitation and marketing?

This can include that you have emailed us a phote of the location.

Maximum Number of delegates incl *

Including Presenters etc.

Other information for members Select if available

Parking available
Lunch
Other, please add details in the box below

Is there any other information you require when Members book

Car registration number, diet etc

Name

64082

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