Course Application Form – Marymount University Hospital & Hospice

Marymount - Course Application Form

Course Details:

Please select the course / programme you wish to apply for:(Required)

Course Date:(Required)

Your Details:

Title:(Required)

Name:(Required)

Home Address(Required)

Contact Telephone Number:(Required)

Email Address:(Required)

Current Employer Details:

Name of employer:(Required)

Work Address:(Required)

Setting:(Required)

Your current role:(Required)

Professional Body:(Required)

Professional Body ( Unlisted)(Required)

Please supply your professional registration PIN here:(Required)

(If not applicable to your application please enter - N/A)

Cancellations:

We understand that, from time to time, you may need to change your plans to attend a course at the Education & Research Centre. Unless otherwise stated on the relevant course page, if you are unable to attend a course for which you have registered, the following cancellation policy applies. All cancellation periods refer to calendar days before the course start date.

Notice of Cancellation	Refund
More than 31 calendar days	Full refund, less a €20 administration fee
15–30 calendar days	80% refund (20% of the course fee is forfeited, subject to a minimum €20 administration fee)
3–14 calendar days	50% refund (50% of the course fee is forfeited, subject to a minimum €20 administration fee)

Less than 3 calendar days or no notice No refund (100% of the course fee is forfeited)

Cancellations must be communicated to the Education & Research Centre by telephone or email. The effective date of cancellation is the date on which notification is received. If you are unable to attend, you may nominate a substitute attendee at no additional cost. Advance notification by telephone or email is required before the course commences.

To notify us of a cancellation or substitute attendee, please contact the Administration Team on (021) 486 9100 or email ewilson@marymount.ie.

Refunds, where applicable, will be processed within 10–14 working days of receipt of the cancellation notice.

Failure to attend a course without prior notification will be treated as a cancellation with no refund.

If Marymount University Hospital and Hospice cancels a course, participants who have paid for their place will receive a full refund of the course fee.

Data Protection:

In accordance with the Data Protection Legislation, we are required to inform you that your details will be retained and held on file for a period of 5 years. This is for administrative purposes only by Marymount University Hospital and Hospice. This information will not be passed on to any other organisation. If, for any reason you no longer wish to consent to us retaining your personal data please send an email to hleahy@marymount.ie.

Declaration:

All information I have provided is accurate. I have read and agree with the terms and conditions of this application.

Course Fee(Required)

Price:

Course Fee(Required)

Price:

Course Fee

Price: € 400.00

Course Fee - Student

Price: € 150.00

Early Bird fee before 01/02/23.

Course Fee(Required)

Price:

Total:

Credit Card:

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