Hospice Palliative Care Academy Booking Form

Palliative Care Academy
Booking Form

We will confirm your place on the event within 3 working days.

By submitting this form I confirm that I have had the opportunity to read the Privacy Notice on the Hospice website – and I consent to you processing my personal data in respect to this specific course, and to enable you to contact me with regards to (similar) courses that I may be interested in. I also understand that my data will only be kept by you for a period of no more than 2 years unless there is a separate legal basis for doing so.
Title of course or event*
Course or event date*

DayMonthYear
Full Name*

TitleFirst NameLast Name
Place of work
Job Role*
Email Address*
example@example.com
Contact Telephone Number
Preferred method of communication

EmailTelephone
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