Learning network: re-designing systems of care application form

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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:
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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
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