Course Booking Form

Booking for Resilience Based Clinical Supervision

Delivered by: Institute of Care Excellence (ICE)
Delivery type: Webinar
Start Date: 08/05/2025
Price: £0.00

Please complete the details below for each attendee you wish to book onto this course.
(Fields marked are mandatory.)

Need any help?

For any questions about course bookings, please email instituteofexcellence@nuh.nhs.uk or call us on 0115 969 1169 Ext: 72666.

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Attendee Information

Title (Mr/Mrs/Miss/Ms/Mx/Dr etc)

First name

Last name

Gender

Male

Female

Other

Prefer not to disclose

Job Title

GMC/NMC number (if applicable)

Division

Department/Ward

Line Manager's Name

Line Manager's Email A copy of the booking details will be sent to this email address for the Line Manager's information.

For the monitoring of Quality and Diversity purposes Health Education England / NHS England would value this information to be collated by all organisations who are awarded CPD funding. This information is sent confidentially and anonymously to HEE/NHSE to ensure that we offer equal access to training and learning at NUH. Our aim at NUH is to ensure equal access to education and training for Nurses, Midwives and AHP's and this data will support this to be achieved.

Are you happy to complete the Equality Monitoring Form?

Yes

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Attendee Contact Details

Attendee's Email Address Please check carefully that the email address you have entered is correct, as it is used for important communications regarding your course, including booking confirmation and, where applicable, payment and access to our e-learning resources.

Telephone (Home/Work)

Telephone (Mobile)

Attendee's Address

Address Line 1

Address Line 2

Address Line 3

Town/City

Postcode

Requirements

Dietary requirements, if applicable

Please also tell us of anything else we should be aware of to support the attendee at this course.