Thank you for registering to attend the Tavistock & Portman NHS Foundation Trust's Open Evenings 2012.
To book you place, please complete the form below, and click on the submit button at the bottom. You will receive a confirmation of your booking by email, or Click Here for Changing Details   of an existing booking.

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Please select the events you like to attend.

Date: Thursday 9th February 2012 Time: 4:30PM - 8.00PM Venue: The Tavistock Centre 120 Belsize Lane London NW3 5BA Attend This One

Date: Thursday 24th May 2012 Time: 4:30PM - 8.00PM Venue: The Tavistock Centre 120 Belsize Lane London NW3 5BA Attend This One

If you have any questions regarding the Open Evenings, please contact:

Education and Training Enquiries:
Telephone: 020 7447 3722
Email: det@tavi-port.org

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Please provide your contact details:
(Note that fields marked with an * are mandatory fields and must be completed.)

* Title:	-- Select -- Mr Mrs Ms Miss Dr
* First/Given Name:
* Surname/Family Name:
* Address:
TEL:
Mobile:
* Email Address:
* Confirm Your Email Address:

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Special Needs:
Please note that the venue is fully wheelchair accessible.
If you have any access requirements for attending the Open Evening, please state briefly the nature of your requirement using the textbox below. This information will be forwarded to the Tavistock’s lead student disabilities officer and will help in meeting your needs at the Open Evening.

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Privacy/Data Protection Statement
We will use the data you have supplied, and we will keep it for the purpose of monitoring and managing the student recruitment process. We may send you further information about the benefits of studying at The Trust.

I consent to you using data in this way.
I do not consent to you using data in this way.

We will use the data you have supplied in the form only in accordance with the Trust’s notification under the Data Protection Act 1998.