training course booking form - Alliance Medical Limited

leading the way
in medical imaging technology

Alliance Medical Ltd.
Training Course Booking Form

Course Name:

Course Date:

Course Cost:

Surname: *

Job Title: *

First Name: *

Title: *

All correspondence relating to this booking will be by e-mail; please provide your e-mail address:

Email: *

Daytime telephone: *

Mobile telephone: *

All personal bookings must be accompanied by the full payment. Hospitals or commercial organisations may be invoiced provided full details are supplied.

Payment Method: (please tick one)

InvoiceAn official purchase order number must be provided in the box below before your booking can be processed.

ChequePlease make cheques payable to Alliance Medical Ltd. Please print this form and post it to us, together with your cheque.

Hospital / Organisation Name: *

Address 1: *

Address 2: *

Town / City: *

Region: *

Postcode: *

Order Number:

This must be provided in order to process your booking form.
Please note that if we don’t receive payment or an official purchase order before the course we will not be able to guarantee a place.

Do you have any dietary requirements?

Vegan Vegetarian Other

Please State:

Do you have any special needs?

How did you find out about the course? Please select

AML flyer

AML website

Word of mouth

Synergy

Other(State)

Submission
By submitting this registration form I agree to Alliance Medical's terms and conditions that apply to this booking.
We will endeavour to process bookings within 10 working days of receipt of the booking form.
If you have not received confirmation within this time please contact the Training Department

Alliance Medical's Training Team will email you soon to confirm your course booking.
For further information please contact the Alliance Medical training team on:
Iceni Centre
Warwick Technology Park
Warwick
CV34 6DA
+44 (0)1926 482014 for MRI and Radiographic Assistants’ courses
+44 (0)1926 482013 for CT and PET/CT courses
training@alliance.co.uk

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Alliance Medical Limited
Iceni Centre
Warwick Technology Park
Warwick
CV34 6DA

Alliance Medical Ltd reserves the right to change course venues, dates and content without prior notification.



	leading the way in medical imaging technology

	Alliance Medical Ltd. Training Course Booking Form Course Name: Course Date: Course Cost: Surname: * Job Title: * First Name: * Title: * All correspondence relating to this booking will be by e-mail; please provide your e-mail address: Email: * Daytime telephone: * Mobile telephone: * All personal bookings must be accompanied by the full payment. Hospitals or commercial organisations may be invoiced provided full details are supplied. Payment Method: (please tick one) InvoiceAn official purchase order number must be provided in the box below before your booking can be processed. ChequePlease make cheques payable to Alliance Medical Ltd. Please print this form and post it to us, together with your cheque. Hospital / Organisation Name: * Address 1: * Address 2: * Town / City: * Region: * Postcode: * Order Number: This must be provided in order to process your booking form. Please note that if we don’t receive payment or an official purchase order before the course we will not be able to guarantee a place. Do you have any dietary requirements? Vegan Vegetarian Other Please State: Do you have any special needs? How did you find out about the course? Please select AML flyer AML website Word of mouth Synergy Other(State) Submission By submitting this registration form I agree to Alliance Medical's terms and conditions that apply to this booking. We will endeavour to process bookings within 10 working days of receipt of the booking form. If you have not received confirmation within this time please contact the Training Department Alliance Medical's Training Team will email you soon to confirm your course booking. For further information please contact the Alliance Medical training team on: Iceni Centre Warwick Technology Park Warwick CV34 6DA +44 (0)1926 482014 for MRI and Radiographic Assistants’ courses +44 (0)1926 482013 for CT and PET/CT courses training@alliance.co.uk Print this page Back to course list>>	Contact us for details of on-site and tailor-made courses. Alliance Medical Limited Iceni Centre Warwick Technology Park Warwick CV34 6DA Alliance Medical Ltd reserves the right to change course venues, dates and content without prior notification.

Tel:+44 (0)1926 482000 Fax:+44 (0)1926 482020 email: info@alliance.co.uk Full contact information Go
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