Re-designing systems of care: Learning network 2015-16 Application form The King’s Fund learning network meetings provide an opportunity for peer-to-peer learning, challenge, and information-sharing, and enable members to work through issues with colleagues facing similar challenges as well as providing protected time for individuals. Key details for this learning network: Will involve participation in five meetings of one day in length, held over a 15 month period. Four people from each community are invited to attend each learning network meeting. Participants should be at director level, and as far as possible there should be some continuity in who attends meetings. Participants should ideally span different health and social care organisations with a shared ambition of developing integrated care locally. Network meetings will be facilitated by Dr Nicola Walsh, who leads our integrated care programme at The King's Fund. Nicola will be joined by relevant external speakers who will be invited to share insights on relevant topics. The group will also be able to draw upon expertise from other staff at the Fund, as well as our latest research and publications. The topics covered at these meetings will be selected in discussion with group members. The first learning network meeting will be held on December 10th at The King’s Fund in London. Details of this and further meetings will be circulated in advance. Each community will also have access to three free conference places, providing an opportunity to learn from UK and international experts. The fee for the learning network will be £5,200 (plus VAT) per community. This fee includes catering and venue costs for meetings; participants will cover their own travel and any hotel expenses. Contact details Please print clearly in black ink or type. Name of key contact: Job title: Organisation and participating community: Work address: Tel.: e-mail: This application is confidential and only to be used for the integrated care learning network. Please return to: Tracy Nottage - t.nottage@kingsfund.org.uk - The King’s Fund | 11–13 Cavendish Square | London W1G 0AN Payment details (Tick one) I enclose a cheque for £ ______________ (+ VAT) payable to The King’s Fund Please charge £ ______________ (+VAT) to my/my organisation’s credit card account (delete as appropriate) Type of card ___________________ (Note: we do not accept American Express) Card # _____________________________ Expiry date __________________ Issue # (Switch/Maestro only) _____________ Valid from ______________ Please invoice me/my organisation (delete as appropriate) Purchase order number (if applicable) ________________________________________________________________ I understand that once this application is accepted, I/my organisation will become liable for the charges, including cancellation charges. Name and address to which invoices should be sent ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Phone ____________________ Email ____________________ Signed ____________________ Date____________ I would like to receive regular email updates from The King’s Fund Signature Date 2