Acute Frailty Network - Frailty First an International Conference Booking Form

Frailty First

An International Conference provided by the Acute Frailty Network

28th June 2018

9am – 4.30pm, Central London, TBC

Please prepare a purchase order before completing this form, as you will not be able to submit it without a PO Number.

Your Details

First Name*

Last Name*

Your job title*

Your organisation name*

Your organisation address*

Contact telephone number*

Your email address*

Full names and job titles of attendees

If you are attending as part of a group please remember to add your own name

Email addresses of attendees

If you are attending as part of a group please remember to add your own email

Dietary requirements

Is your organisation a member of AFN, AEC, SAEC or NHS Elect?*

Yes

Invoicing details

Members price £149.00 (or £496 for 4)

Non members price £189.00 (or £596 for 4)

Name of person to address invoice to*

Email address for invoicing purposes*

Invoicing address*

Purchase Order Number *

Please note that we will not be able to confirm your place until we receive the PO number

Invoicing telephone number*

* required field(s)