MASCIP 2025 Delegate Booking Form

The 27th Annual Conference

Thursday 13th November 2025
FOCUS ON FUNDAMENTALS: Strengthening the Essentials
How many delegates are you booking for? (If you would like to book for more than 4 delegates then please complete another booking form for the remaining delegates)*

1234
PO Number (if applicable) PLEASE NOTE THAT IF THE INVOICE IS BEING SENT TO ROYAL NATIONAL ORTHOPAEDIC HOSPITAL OR EAST SUFFOLK & NORTH ESSEX NHS FOUNDATION TRUST, A PO NUMBER MUST BE PROVIDED.
If applicable, please obtain a Purchase Order (PO) number from your employer/payee and enter it above.
Email address to send the invoice to*

DELEGATE 1
PACKAGE
Includes access to MASCIP conference, with lunch and refreshments provided.*

£175 (Delegate rate)£195 (Delegate rate plus personal assistant)
Would the delegate like to attend the 'Mix and Mingle' buffet the evening before, at an extra cost of £15 per person? (Wednesday 12th November 2025, 7.30pm to 9.30pm)? Please note that spaces for this are limited.*

YesNo
BOOKING DETAILS
Delegate Name*

First NameLast Name
Delegate MASCIP Membership Number
Delegate Spinal Injury Unit and Hospital or Company Name*
If you selected 'Other' above, type the delegate hospital or company here. Otherwise if a spinal injury unit was selected above, type 'N/A'*
Delegate Job Title*
Delegate Mobile Telephone Number*
Delegate Email Address*
Is the delegate a wheelchair user?*

YesNo
Delegate Dietary Requirements (if any)*
If the delegate has no dietary requirements then please type 'None.'
Delegate Access Requirements (if any)*
If the delegate has no access requirements then please type 'None.
Personal Assistant (PA) Full Name (if applicable)
Personal Assistant (PA) Dietary Requirements (if any)
If the PA has no dietary requirements then please type 'None.'

DELEGATE 2
PACKAGE
Includes access to MASCIP conference, with lunch and refreshments provided.*

£175 (Delegate rate)£195 (Delegate rate plus personal assistant)
Would the delegate like to attend the 'Mix and Mingle' buffet the evening before, at an extra cost of £15 per person? (Wednesday 12th November 2025, 7.30pm to 9.30pm)? Please note that spaces for this are limited.*

YesNo
BOOKING DETAILS
Delegate Name*

First NameLast Name
Delegate MASCIP Membership Number
Delegate Spinal Injury Unit and Hospital or Company Name*
If you selected 'Other' above, type the delegate hospital or company here. Otherwise if a spinal injury unit was selected above, type 'N/A'*
Delegate Job Title*
Delegate Mobile Telephone Number*
Delegate Email Address*
Is the delegate a wheelchair user?*

YesNo
Delegate Dietary Requirements (if any)*
If the delegate has no dietary requirements then please type 'None.'
Delegate Access Requirements (if any)*
If the delegate has no access requirements then please type 'None.
Personal Assistant (PA) Full Name (if applicable)
Personal Assistant (PA) Dietary Requirements (if any)
If the PA has no dietary requirements then please type 'None.'

DELEGATE 3
PACKAGE
Includes access to MASCIP conference, with lunch and refreshments provided.*

£175 (Delegate rate)£195 (Delegate rate plus personal assistant)
Would the delegate like to attend the 'Mix and Mingle' buffet the evening before, at an extra cost of £15 per person? (Wednesday 12th November 2025, 7.30pm to 9.30pm)? Please note that spaces for this are limited.*

YesNo
BOOKING DETAILS
Delegate Name*

First NameLast Name
Delegate MASCIP Membership Number
Delegate Spinal Injury Unit and Hospital or Company Name*
If you selected 'Other' above, type the delegate hospital or company here. Otherwise if a spinal injury unit was selected above, type 'N/A'*
Delegate Job Title*
Delegate Mobile Telephone Number*
Delegate Email Address*
Is the delegate a wheelchair user?*

YesNo
Delegate Dietary Requirements (if any)*
If the delegate has no dietary requirements then please type 'None.'
Delegate Access Requirements (if any)*
If the delegate has no access requirements then please type 'None.
Personal Assistant (PA) Full Name (if applicable)
Personal Assistant (PA) Dietary Requirements (if any)
If the PA has no dietary requirements then please type 'None.'

DELEGATE 4
PACKAGE
Includes access to MASCIP conference, with lunch and refreshments provided.*

£175 (Delegate rate)£195 (Delegate rate plus personal assistant)
Would the delegate like to attend the 'Mix and Mingle' buffet the evening before, at an extra cost of £15 per person? (Wednesday 12th November 2025, 7.30pm to 9.30pm)? Please note that spaces for this are limited.*

YesNo
BOOKING DETAILS
Delegate Name*

First NameLast Name
Delegate MASCIP Membership Number
Delegate Spinal Injury Unit and Hospital or Company Name*
If you selected 'Other' above, type the delegate hospital or company here. Otherwise if a spinal injury unit was selected above, type 'N/A'*
Delegate Job Title*
Delegate Mobile Telephone Number*
Delegate Email Address*
Is the delegate a wheelchair user?*

YesNo
Delegate Dietary Requirements (if any)*
If the delegate has no dietary requirements then please type 'None.'
Delegate Access Requirements (if any)*
If the delegate has no access requirements then please type 'None.
Personal Assistant (PA) Full Name (if applicable)
Personal Assistant (PA) Dietary Requirements (if any)
If the PA has no dietary requirements then please type 'None.'

IMPORTANT INFORMATION: PAYMENT DETAILS
- Upon receipt of your booking form, an invoice (including payment details) will be sent to the email provided.
- Payment must be made prior to attendance. NO payment will mean NO entry.
- Please ensure you include the invoice number as a reference when submitting payment.
- A confirmation email/receipt will be provided once payment has been received. Please do not travel without this confirmation.
- For international payments, payments must be sent in GBP and you must ensure that all bank charges are covered. If a payment made is less than the invoice amount then an additional handling fee will be charged.
TERMS AND CONDITIONS
1. Payment

1.1 The price of the event is as stated on this booking form.

1.2 Payment of the price in full must be sent to MASCIP (payment details as stated on the invoice) no later than one week prior to the event. If payment is not received, MASCIP reserve the right to resell the allocated ticket. If the ticket remains unsold then the invoice will remain payable.

2. Dietary and accessibility requirements

2.1 Notice of special dietary and accessibility requirements should be stated on this booking form. MASCIP cannot be held responsible if these details are omitted from this form.

3. Cancellation and variation by MASCIP

3.1 MASCIP reserves the right to cancel the event or arrange an alternative date. In the event of cancellation, MASCIP will invite the customer to attend an equivalent event, where available, at the same price. Alternatively, a full refund will be given.

4. Cancellation, transfers and substitutions by the customer

4.1 MASCIP must be notified of any cancellations in writing no later than two weeks prior to the event.

4.2 No refund will be given where the customer cancels less than two weeks prior to the event.

4.3 No refund will be given where the customer fails to attend the event.

4.4 Where the customer is unable to attend the event, MASCIP will accept a substitute delegate provided full details including name, email address, contact telephone number and dietary/access requirements are provided, before the day of the conference.

5. Delegate details

5.1 When the customer makes a booking, they will be registered for a free MASCIP membership.

5.2 All delegates details will be placed on a list and provided to all delegates attending the conference. The details include full name, job title and place of work.
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