* 1. Your Name

* 2. Job Title

* 3. Contact Email Address

* 4. Faculty / Service Area

* 5. Please outline 3 main development objectives that you would like to achieve by completing this programme. Consider highlighing: personal, professional or team benefits.

* 6. On Tuesday evening there is the opportunity to stay on and attend an evening dinner (starting around 6pm). Would you like to attend the evening dinner?

* 7. Do you have any special requirements for you to participate in the programme?

* 8. I can confirm that I have discussed attendance on this programme with my line manager and that they support my attendance on this programme.