TECNA COURSE APPLICATION FORM

Please complete this form in BLOCK CAPITALS and return with remittance.
I would like to attend the

SELECT COURSE* 26th TECNA COURSE 12th March 2022 (SAT) - MANCHESTER - £200.00 GBP 27th TECNA COURSE 10th September 2022 (SAT) - BRISTOL- £200.00 GBP Surname*
Job Title* Registered Nurse Endoscopy Nurse Endoscopy Unit Manager Health Care Assistant Doctor Company Rep Others(specify)
Country* Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint LUCIA Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe Hospital or Other Organisation* Address For Correspondence* Day Time Tel Mobile*

Email* Forename* if others specify Department* Trust Postcode* Ext/Bleep Fax

Payment Type*:

BACs Transfer (Bank transfer) Please visit www.scopehealthuk.com for online payments. You will be requested to register for this. For any queries email your doubt and contact number to admin@scopehealthuk.com. we will contact you back at the earliest possible

I enclose a cheque payable to: "SCOPE HEALTH"

Invoice my organisation.

Please state to whom invoices should be addressed. (MANDATORY) Name Address Please include all email address Tel

If no alternative contact is given, all invoices will be directed to the applicant.

I would like to pay by PayPal ( www.tecnainfo.com or www.scopehealthuk.com for payment)

I wish to attend the TECNA networking and social event ( TECNA CONNECT ) *

Yes

No

Special Requirements ( Diet, Access etc)*

Veg

Non - Veg

Others - Specify Below

I wish to receive future TECNA course info/news letters/updates etc. *

Yes

No

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In sending this application form I agree to the terms/conditions and confirm that I have read the privacy policy and terms of service stated below/TECNA website (www.tecnainfo.com).

PAYMENTS
Payments:We request an official purchase order or letter from the unit manager should accompany your registration form (at least 4 weeks prior to the closing date to secure a place) or unless you have requested an invoice to be sent to you or your organisation. Attendance is conditional upon advance payment being received prior to the event. Failure to pay prior to the event may result in attendance being refused.

CANCELLATION POLICY
Refunds cannot be given in the event of your cancellation within 4 weeks of the course date. We cannot accept liability for costs incurred in the event of the symposium being cancelled as a result of unforeseeable circumstances. The TECNA course organisers reserve the right to cancel or postpone the course in which case the course fees will be refunded in full. In the event of cancelation the TECNA course organisers will not be held liable for delegates travel, accommodation or any other expenses incurred. Places are limited, please register early. On registration further information will be mailed at least 2-4 weeks prior to the course. We appreciate that all communications relating to the course are sent via email.

COURSE PHOTOS / VIDEOS
During the course photos and videos may be taken for future use i.e. presentations, course promotions, website development or publications. If there are any objections please inform the course organiser or course coordinator in advance.

DISCLAIMER
Information contained in the brochure was correct at the time of publication. However, it may be necessary, due to unforeseen circumstances for sections to be changed. The organisers will endeavour to keep changes to a minimum. Delegates are also advised to refer to the PRIVACY POLICY & TERMS OF SERVICE.

PRIVACY POLICY AND TERMS OF SERVICE
Delegates are advised to familiarise with the Privacy policy & terms of service .If there are any queries please contact the course organisers.