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    Name of course (required)

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    Cost of course (required) (an administration fee of £20 per person will be added to the course fee. Please add this additional £20 here e.g. cost of course: £165 for one day course, £290 for a 2-day course and £435 for a 3-day course)

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    Please note: refunds will only be made if the cancellation is received in writing at least one month prior to the course.

    Invoices to employing organisations can be raised in exceptional circumstances only. If you wish to apply to use this method please provide the following details:

    Name of contact at paying organisation:

    Contact telephone number:

    Contact email:

    Contact postal address:

    Purchase order number:

    We require the purchase order number before your place on the course is confirmed. If you do not have this yet, please email it to us as soon as possible to confirm your place on the course.

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    I consent to these details being stored on the Michael Palin Centre database so that I will be kept informed of training, development opportunities and MPC events

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    Charitable donations to the Michael Palin Centre are administered by The Whittington Health Charity, Registered Charity Number 1056452 www.whittingtonhealthcharity.org. For this purpose alone, The Whittington Health Charity will also hold your details. We take your privacy seriously and will never sell or swap your details with other third parties. You can withdraw your consent to be contacted at any time by calling 020 3316 8100 or by emailing [email protected] Information about how the Trust protects personal data is set out in our privacy policy.
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