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Primary Care Education Sessions - Expression of Interest Form

Upon submission of this request, your details will be added to our Expressions of Interest (EOI) register. Once the minimum number of participants required to proceed has been reached, we will contact you to confirm eligibility and a training session date with at least 6-weeks notice.
1.Full name(Required.)
2.NHS email address(Required.)
3.Job role(Required.)
4.Contact number (in case of cancellation/changes)(Required.)
5.Practice name(Required.)
6.PCN name(Required.)
7.Practice Manager name(Required.)
8.Practice Manager's email address(Required.)
9.Which area of West Yorkshire do you work in?(Required.)
10.What course(s) are you applying for?
11.You must have permission from your Practice Manager to apply for this course and ensure you can be released from practice to attend(Required.)
12.We will need to share your details with the training provider to allow them to book you onto the chosen training.(Required.)
13.You will automatically be added to our distribution list to receive our fortnightly WY PCWTH Bulletin containing information on our programmes/courses/training/funding etc.. If you wish to opt out, select the following box.
14.Please leave any comments or questions in the textbox below.