MIP Speaker Form "*" indicates required fields Step 1 of 3 33% Management in Practice 2024 Speaker RegistrationEvent Selection*-Please Select-Management in Practice Live Birmingham - 14 May 2024Management in Practice Live Manchester - 6 June 2024Management in Practice Live London - 3 September 2024Management in Practice Live Newcastle - 23 September 2024Event Information Date: 14 May 2024 Location: Birmingham - NCC Date: 6 June 2024 Location: Manchester - Bridgewater Hall Date: 3 September 2024 Location: London - Novotel London West Date: 23 September 2024 Location: Newcastle - Hilton Newcastle Gateshead Your DetailsName* -Please Select-DrMissMrMrsMsProf Title Forename Surname Email* Enter Email Confirm Email Which job title most closely matches your job role:*-Please Select-Assistant Practice ManagerGP PartnerSessional GPManagerPractice Director/PartnerPractice ManagerPractice Secretary/Administrator/ReceptionistOther, Please SpecifyOther Job Role* If none of the above describes your role please select 'other' and provide details of your role. 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I have the right to contact them to have my data removed or to not have my badge scanned. The personal data provided in this form will be processed in accordance with UK law by Cogora Group Ltd. In addition to the purposes described above, we may process your information for carefully considered and specific purposes to enhance the services we provide. You have the right to object to this processing if you wish. For further details on how Cogora Ltd may process your information and your rights in relation to the information we hold on you, please visit our privacy policy or telephone us on 020 7214 0500. Please note that your name, phone number and email address may be passed onto third parties including, but not limited to, the venue, public health authorities and NHS, for the purposes of contact tracing purposes.Cogora Limited Registered in England No. 02147432 Registered Address: 1 Giltspur St, London EC1A 9DDSpeaker DeclarationBy signing, I agree that I am aware that there may be journalists present at the event from Cogora, the organiser of the events, and external media and that details of my seminar/workshop may be reported. Cogora may also record the session and share my presentation with delegates and other relevant members of the healthcare community. I consent for video footage of me/my session to be shared with delegates and relevant healthcare professionals online by Cogora.* Yes No I consent for photographs of me/my session to be used for marketing and PR purposes by Cogora.* Yes No I consent for my presentation to be shared with delegates and relevant healthcare professionals after the event.* Yes No Sign (type your name)* HiddenAdmin- Please enter the Event/Issue ID's into the relevant box. - Please enter the marketing reference.HiddenMarketing Reference