Bliss Study Day - Mental Health

Study Day: Mental Health registration form

Thank you for your interest in the Bliss study day on mental health. Please fill in the details below and a member of the team will be in touch.

Course details

Course you would like to attend

Your details

Title

First name

Last name

Email address

Phone number

Type of phone number

What is your role?

If other please give details

Do you have any dietary requirements?

E.g. vegetarian. Please let us know in the box below.

Your hospital's details

Name of hospital

Address line 1

Address line 2

Town or City

Postcode

What is your hospital's network?

Billing

The course fee is £60

How will the course be paid?

If the course is to be paid for by the delegate please give the following information

Billing address line 1

Billing address line 2

Billing address line 3

Billing address town or city

Billing address postcode

Email address

Purchase order number (if relevant)

Your place will only be confirmed when payment is received.

Payment terms are 14 days from receipt of invoice. Payment must be received 21 days prior to the start of the course.

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Let's keep in touch

Your support helps the most vulnerable babies in the UK. We’d love to keep you updated with news about our work and ways you can get involved with Bliss. Are you happy to be contacted by:

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Your privacy

We (Bliss and Bliss Scotland) promise we will use the personal data you have provided to communicate in the way(s) you have agreed to.

We will not pass on your details on to any third party organisation for their marketing purposes.

Find out how we look after your personal details in our Supporter Promise

You can opt our of all communications from Bliss at any time by calling the Supporter Engagement Team on 020 7378 5740 or emailing supporters@bliss.org.uk.