Application for Patient Liaison Officer (PLO) Development Programme

Application for Urine Infection training

Name of Applicant: (Print)…………………………………………………………………………

Job title ……………………………………………………………………………………..

Company/Home/Organisation name and postcode……………………………………………

Contact number ………….………………………………………………………………………..

Email address for correspondence………………………………………………………………

Name of supporting manager (Print)……………………………………………………………

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I wish to apply for a place on the urine infection training session, (please refer to the attached timetable of dates and venues on the next page)

1st choice date/venue

2nd choice date/venue

Signature of applicant…………………………………………………………

Date:……………...

*I confirm that on behalf of the company/organisation named above, that I agree to pay on invoice, the sum of £100 to Bromley CCG, for non-attendance of the applicant at the confirmed training session, without prior notice of at least 48 hours

Signature of supporting manager………………………………………………………… Date:…………..…

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Each training session is approximately 2.5 - 3 hours. The training is provided free to attendees from organisations/companies that provide care to Bromley residents.

Confirmation dates will be sent via email within 1 week of the application receipt.

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Please return your completed form (Page 1 only) by email to [email protected] or by fax 01689880950

For all enquiries please ring the ProMISE team at Bromley CCG tele:01689880583

of 3 Dates and venues for Urine Infection training

August:

 Monday 12th 13:30 – 16:30 Boardroom, Bassetts House

 Friday 16th 13:30 – 16:30 Muirhead Room, Beckenham Beacon

 Monday 19th 09:30 – 12:30 Muirhead Room, Beckenham Beacon

 Friday 30th 13:30 – 16:30 Boardroom, Bassetts House

September:

 Monday 2nd 09:30 - 12:30 Committee Room 1, Civic Centre

 Monday 9th 13:30 – 16:30 Boardroom, Bassetts House

 Tuesday 10th 09:30 – 12:30 Training Room, Bridges Healthcare

 Friday 13th 13:30 - 16:30 Committee Room 2, Civic Centre

 Monday 16th 13:30 - 16:30 Committee Room 1, Civic Centre

 Monday 23rd 14:00 – 17:00 Boardroom, Bassetts House

 Friday 27th 09:30 - 12:30 Boardroom, Bassetts House

October:

 Tuesday 1st 09:30 – 12:30 Boardroom, Bassetts House

 Tuesday 8th 13:30 - 16:30 Boardroom, Bassetts House

 Tuesday 15th 09:00- 13:00 Boardroom, Bassetts House

 Monday 28th 09:30 – 13:30 Muirhead Room, Beckenham Beacon

Please note there are only 15 places available per session.

Bassetts House, Broadwater Gardens, Orpington, Kent, BR6 7UA

Muirhead Room, Beckenham Beacon, 379 Croydon Road, Beckenham BR3 3FD

Committee Rooms, Civic Centre, Stockwell Close, Bromley BR1 3UH

Bridges Healthcare, Wells House, 3rd Floor, 15 Elmfield Road, Bromley BR1 1LT

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