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DEMENTIA SERVICES INFORMATION AND DEVELOPMENT CENTRE WORKSHOP BOOKING FORM


Dementia Services Information and Development Centre


WORKSHOP BOOKING FORM


NAME






JOB TITLE








ORGANISATION &

ADDRESS




EMAIL: TEL:


CONTACT DETAILS



COURSE NAME



COURSE DATE



PAYMENT DETAILS Payment Method - please tick preferred option and fill in the relevant details


1. Cheque. Please make cheques payable to St James’s Hospital Foundation and post to Lorraine Lovely, DSIDC, Sixth Floor MISA, St James’s Hospital, Dublin 8 with completed booking form.


2. Invoice. We can invoice your organisation using your company’s purchase order system.

Please obtain a purchase order number before booking and attach the order to this form.


Purchase Order Number ______________________

Bank: Bank of Ireland

Branch: James’s Street, Dublin 8

Account Name: St James’s Hospital Foundation

Account Number: 61216251

Sort Code: 909599

IBAN Number: IE98BOFI90959961216251

BIC Number: BOFIIE2D

Please include reference

2318

on the Bank Transfer Form and return booking form with payment details to [email protected]


3. Bank Transfer








Signature : Date:


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