To Register RC P S G

Please make cheques payable to Royal College of Physicians

and Surgeons of Glasgow and send with your completed
registration document to:

Donna McCann
Education & Professional Development Unit
Royal College of Physicians and Surgeons of Glasgow
232 – 242 St Vincent Street
Glasgow
G2 5RJ
26th TC White
Symposium
Please note your registration will only be confirmed and a place
reserved once your registration fee has been received.

Booking cancellation Surviving Dentistry:

We regret that refunds cannot be made for cancellations within five Looking after yourself
days of the event. Education and your team

WHEN IN COLLEGE YOU ARE WELCOME TO USE THE LIBRARY ON An exciting day of professional
THE 2nd FLOOR FOR PRIVATE STUDY, ACCESS TO THE INTERNET, and personal development for
EMAIL AND REFERENCE WORKS: the whole dental team
OPENING HOURS: 9.00am until 5.00pm
MONDAY TO FRIDAY

Friday 13th May 2011

Royal College of Physicians and Surgeons of Glasgow

232 – 242 St Vincent Street
Glasgow
G2 5RJ
t: 0141 227 3240
f: 0141 221 1804
email donna.mccann@rcpsg.ac.uk
www.rcpsg.ac.uk
03.11
 Surviving Dentistry: Looking Registration Form
after yourself and your team
26th TC White Symposium - Friday 13th May 2011

An exciting day of professional

and personal development for Name
the whole dental team.
Position

Hospital (if applicable)

Address for correspondence

Postcode

Home Tel

Work Tel (if applicable)

Email

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I wish to register for the above event

 Full fee £165.00  Trainee fee £90.00
 Allied Health Professional(AHP)/Nurse Fee £100.00
 Dental Care Professionals (DCP’s) Fee £45.00
 RCPSG Introductory Member Fee* £65.00  RCPSG Fellow/Member Fee* £65.00
Payment charges: Please note that should your payment fail, and consequently RCPSG incurs a charge, then a standard administration fee of
£20 (inc VAT) will apply. Should you wish to make further inquiries relating to payment charges please contact RCPSG Finance Dept. This fee
must be paid prior to submitting an application for any other activities within the College.

 I enclose a cheque for £

Please make cheques payable to:
Royal College of Physicians and Surgeons of Glasgow

 I wish to make payment by credit card for £

Cardholder Name
Further Enquiries: CPD & CPDA Credit Card Number
Donna McCann Applied For
T- 0141 227 3240 F- 0141 221 1804 Type of Card (eg Visa, Mastercard)
Email: donna.mccann@rcpsg.ac.uk (please note – we do not accept payment by American Express card)

www.rcpsg.ac.uk Card Expiry Date Security Code

BOOK ONLINE at http://www.rcpsg.ac.uk/Education/Events/ * Please provide RCPSG Membership Number on above form.