Southampton Sleep Training Programme Registration Form

Name*

First NameLast Name

Work Email*

example@example.com

Who is your current employer?*

What is your Professional Role?*

Doctor (including level of training and speciality), Nurse (speciality and banding), Allied Health Professional (speciality)

What country do you practice in?*

Please state your country

Please select the module (s) that you would like to attend:*

Module 1a - Basic Sleep Know HowModule 1b - Sleep Basics for Everyday PracticeModule 2 - Disorders of SleepModule 3 - Managing Sleep Problems in Neurodevelopmental DisordersModule 4 - Managing Sleep Problems in Children with Physical Disability and Sensory ImpairmentModule 5 - Managing Chronic Insomnia

Module 1 is a pre-requisite for completing the other modules. This is because of previous experience and feedback that some attendees have not been able to take full advantage of the later modules without the core training completed in Module 1.

If you have completed module 1 previously, please state the year in which you completed.*

If you have completed an equivalent sleep course please provide details and date of completion

Any further comments

Cancellation Policy

In the event of a cancellation made 6 weeks prior to the course starting, you will receive a refund for the module that you are unable to attend. You will be offered to transfer onto the module the following year, or you will be able to transfer your place to someone else within your organisation. Unfortunately, cancellations made within 2 weeks prior to the course starting will not be able to be transferred to someone else or transferred onto the module the following year.

Refunds requested within 6 weeks of the course date will be considered in exceptional circumstances and reviewed on a case-by-case basis.

Payment or invoice information must be received at least 6 weeks in advance. We will contact you 8 weeks prior to the course and if no response or payment information is provided your place(s) will be released.

Do you consent for your email address to be added to the Southampton Sleep Training distribution list? Only training and educational information will be sent and your email address will not be shared with a third party.*

YesNo