Nicotine And Tobacco: Postgraduate Cpd Course For Practitioners


Nicotine and Tobacco: Postgraduate CPD Course for Practitioners
For office use only:
About You:
Title ______ Surname ____________________________ First name ______________________________
Date of birth: _________________________________
Gender: (√)
Male ____ Female _____
Home address, including postcode __________________________________________________
Country of Domicile (if other): _________________________________________________________________
Nationality: _______________________________
Tel No Daytime: _________________________________
Mobile: ______________________________
E-mail: _____________________________________________
2. Professional & Academic:
Job Title and Profession: _______________________________________________________________________
Organisation name and address: ________________________________________________________________
Please describe your current role, interest in this topic and reasons for wishing to attend the course:
Course Choices & Costs
If you book and pay before 29th February 2016 the cost is: £450 or £599 for students seeking accreditation. From
February, the price is £550 unaccredited or £699 if seeking accreditation.
In all cases these prices cover lunch on arrival as well as lunches and refreshments throughout the course, a
networking dinner on Monday evening, 9
May and a packed lunch on departure. Accommodation is not included
but can be booked on your behalf (see below).
Please indicate (√) if you wish to take the course as a stand-alone course for professional development
(unaccredited) or accredited at Masters Level (10 credits). NB: If you choose the latter, you will be required to submit
a 3000 word assignment for assessment after the course and you must have an undergraduate degree in any
I wish to take the course as a stand-alone course, without accreditation. ➔
I wish to take the module with accreditation➔
Please give details of your undergraduate degree or higher
qualification if you have one:
Highest Qualification: _________________________
Awarding Institution: ____________________ Year: _____
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