Registration -

Title *

Name *

First

Last

Job title *

Organisation *

If you are a SLaM employee, please provide your work details

Department *

Work Address *

Postcode *

Email *

Work Telephone *

Mobile (optional)

Please specify any special dietary requirements *

Other special dietary requirements/Allergies

Please specify any special access requirements

Are you registering more than one delegate? *

Yes
No

If no, please proceed straight to payment choice below

If you are registering for more than one delegate, is the department and work address the same as primary delegate?

Yes
No

If no, please provide department and work address

Delegate 1: Please provide job title, full name, email address, work number and any dietary/access requirements

Delegate 2: Please provide job title, full name, email address, work number and any dietary/access requirements

Delegate 3: Please provide job title, full name, email address, work number and any dietary/access requirements

Delegate 4: Please provide job title, full name, email address, work number and any dietary/access requirements

Delegate 5: Please provide job title, full name, email address, work number and any dietary/access requirements

Please select payment choice *

Invoice
Cheque
BACs (please contact event organiser)

Please make cheques payable to KING’S COLLEGE LONDON and send to Sandy Chang, Pharmacy Department, Maudsley Hospital, Denmark Hill, London SE5 8AZ. Cheques must be paid in UK Sterling (£). Please ensure the cheque(s) are completed correctly, checking they are signed, dated appropriately and that the words and figures agree with each other.

How did you hear about this event? *

Advert in British Journal of Psychiatry
Conference Alerts
Maudsley Prescribing Guidelines International Conference website
Institute of Pharmaceutical Science website
Institute of Psychiatry, Psychology and Neuroscience
SLaM news
Through KCL e-store
Word of mouth
Other (please specify)

Please confirm you have read and accept our terms and conditions below: *

Yes, I acknowledge that I have read and agree to the Terms and Conditions