TAKING NEONATAL CARE TO THE NEXT LEVEL CONFERENCE BOOKING FORM 19 MAY 2015, ROYAL INSTITUTION, LONDON Please complete this form and return it to: UNICEF UK Baby Friendly Initiative, 30a Great Sutton Street, London EC1V 0DU Telephone: 020 7375 6144 Fax: 020 7250 1733 Email: [email protected] Please complete one form per person Please complete all fields using BLOCK CAPITALS NAME JOB TITLE ORGANISATION ADDRESS (INCLUDING POSTCODE) TELEPHONE EMAIL BOOKING (Please tick the box below to book your place. Booking deadline is Tuesday 12th May 2015) qPlease book ONE place (19 May, 2015) at £95 [BF72N] PAYMENT (Please note we cannot reserve places in advance of payment.) For payment by cheque, please make payable to UNICEF and write the delegate’s name clearly on the back of the cheque. For payment by invoice, please send a copy of the official purchase order form with this form. For payment by credit card, please provide the following information: Card number: Start date: ........ Expiry date: ........ Security no: ......... Issue no (if applicable): ...... Signature: ........................... Full address card registered at: .................................................................................................................................. ...................................................................................................................................................................................... Please indicate any special dietary requirements How did you hear about this Conference? We will confirm your booking and provide full conference details by email within two weeks of receiving this completed form and payment. If you do not receive confirmation, please call 020 7375 6144. If you sent your form via your manager or finance department, do check with them first. Cancellations will only be considered in writing and must be received by 10 April 2015 - an administration fee of £30 will be charged. No refund will be given after this date. Substitutions will be accepted in writing until 12 May 2015. Please refer to our terms and conditions on the UNICEF UK Baby Friendly Initiative website at unicef.org.uk/babyfriendly Your email address will be added to the News Mailing services for the UNICEF UK Baby Friendly Initiative. If you do not wish it to be added, please tick here. q The Baby Friendly Initiative is a programme of the UK Committee for UNICEF. Registered Charity no. 1072612 (England and Wales), SC043677 (Scotland).