TGI Course Booking Form

Training Needs *

Special requirements (dietary or access needs) *

I would like to book a place on the following course(s) *

Online masterclass in Laparoscopic Upper GI Surgery (£25) 1st March 2021 Online masterclass in Laparoscopic Lower GI Surgery (£25) 26th February 2021 *Cadaveric workshop in laparoscopic Upper GI Surgery (£600) 4th March 2021 *Cadaveric workshop in laparoscopic Lower GI Surgery (£600) 5th March 2021 **Basic microsurgery course (£1600) 7th - 11th June 2021 **Basic microsurgery course (£1600) 28th June -2nd July 2021

*If you are booking a place on a human cadaveric training course, please ensure you have read and understood section 3 of our booking conditions *

I have read and understood the guidance for working with HTA licensed material at the Griffin Institute

** If you are booking a place on an in-vivo training course, please give your consent for us to contact you regarding your Home Office personal licence application (see section 2 of our booking conditions) *

I consent to the Griffin Institute retaining my contact information for liaison regarding my Home Office personal license application

Payment information

Choose your preferred payment option: *

Bank transfer/ BACS Invoice to employer

Bank transfer details:
Please use your name as a reference
Bank: Lloyds PLC
Sort code: 30 93 92
Account number: 01886519
Payee: NPIMR

To request an invoice, please complete the follo wing:

Purchase order number *

Invoice Address *

Please select the following options in order for us to process this booking *

I have read and agree to the Griffin Institute booking conditions I consent to the Griffin Institute retaining my contact information for the purpose of communication regarding the course(s) that I will be attending

Please choose any of the follow options regarding future communication *

I consent to the Griffin Institute retaining my contact information for the purpose of communication regarding future courses that may be of interest to me I consent to the Griffin Institute retaining my contact information in order to send regular Newsletters or updates, which may include communication regarding fundraising for their charitable purposes

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Course Booking Form

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