ePACT.net Training - booking form

For enquires and provisional bookings please telephone 0191 2035040 or email

ePACT.net Training - Booking Form

Your Personal Data
The Prescription Pricing Authority will use your name and telephone number to manage the administration process of your attendance on the course requested. Your personal data will be sent via e-mail across the Internet to the PPA. We will not disclose your Personal Data to any third party or transfer it outside of the EEA. Your Personal Data will be held until both payment is received and you have attended the course.

Orange fields are mandatory - Please complete all mandatory fields. (also marked with a * for older browsers)

*Name

*Telephone
number

Fax number

Organisation Type:

PCT

PCG

CNPC

Organisation name and address:

Invoice address:(if different from above)

Training etc

Training required:

Basic

Intermediate

Advanced

*Date Required:

Preferred payment type:

Cheque

Bacs

Invoice

Tick this box to indicate the you accept the Terms and Conditions. If you have not read them, then please click here.