Course Application Form

Course Details:

Please select the course / programme you wish to apply for:(Required)

Course Date:(Required)

Your Details:

Title:(Required)

Contact Telephone Number:(Required)

Email Address:(Required)

Current Employer Details:

Name of employer:(Required)

Address:(Required)

Setting:(Required)

Your current role:(Required)

Professional Body:(Required)

Professional Body ( Unlisted)(Required)

Please supply your professional registration PIN here:(Required)

(If not applicable to your application please enter - N/A)

Cancellations:

14 days-notice is needed to cancel your registration in order to receive a full refund (Minus a €20.00 Admin fee). If cancellation is less than 14 days you may only receive a 50% refund. Each case will be reviewed on an individual basis taking any unforeseen circumstances preventing your attendance into account. Marymount University Hospital and Hospice reserve the right to cancel a programme, in which case a full refund will be issued.

Data Protection:

In accordance with the Data Protection Legislation, we are required to inform you that your details will be retained and held on file for administrative purposes only by Marymount University Hospital and Hospice. This information will not be passed on to any other organisation.

Declaration:

All information I have provided is accurate. I have read and agree with the terms and conditions of this application.

Course Fee(Required)

Price: 400,00 €

Course Fee(Required)

Price: 200,00 €

Course Fee - Early Bird

Price: 300,00 €

Early Bird fee before 01/02/23.

Course Fee - Early Bird Student

Price: 125,00 €

Early Bird fee before 01/02/23.

Course Fee(Required)

Price:

Total:

Credit Card:

Marymount - Course Application Form

Course Details:

Your Details:

Current Employer Details:

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