Please note that there a £15 per-learner registration fee for all our City & Guilds programmes*

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* 1. Which course are you applying for?

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* 2. Workshop date you wish to enrol for. (this is for the follow up workshop). Please ensure you have also booked on Workshop 1 

Date
Please enter your name as you would like it to appear on your certificate and digital credential

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* 3. Your given name (first name)

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* 4. Your middle name
(only provide this if you want it included on your Certificate and Digital Credential).

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* 5. Your family name (surname).

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* 6. Your date of birth (this is an essential requirement for City & Guilds registration).  Please use the format: dd.m.yyyy

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* 7. Your gender (this is inessential requirement for City & Guilds registration).

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* 8. Your organisational details

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* 9. Your email address (where the City & Guilds Digital Credential is to be emailed).

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* 10. Your mobile telephone number (so that we can contact you during the course with any urgent information).

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* 11. Your line manager's name

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* 12. Your line manager's email address

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* 13. Please use the box below to let us know about any special requirements you have and which we will need to be aware of during this programme.

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* 14. How did you hear about this course?

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* 15. Would you like us to keep your contact details on file so that we can let you know when we are recruiting to our other courses?

Payment information

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* 16. Are you a private (*profit-making) organisation or an organisation outside of the London Boroughs of Lambeth, Lewisham or Southwark?

If yes, then we will need to charge you the standard course fee of £100 per day in addition to the £15 City & Guilds registration fee.  Please contact estiacentre@slam.nhs.uk for more information before making payment.*
Making your payment
An invoice will be sent you before the follow up City and Guilds training.

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* 17. I confirm that I have checked all the information on this form and it is correct.  I confirm that I am required to provide at least 24 hours notice of my non-attendance at any workshop and that failure to do so will incur a £50 charge.

I affirm that entering my name and date and by clicking 'submit application' will will constitute an electronic signature of this form.

'On clicking 'submit application' your details will be logged on our system and we will email you one week before the course start date with further information and joining instructions.

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