Application Form

Application Form
Special Application Reference No.*
(Only used if applying under special circumstance given by DOCET, this reference number would be given to you by DOCET.)
Organiser Details
Organising Body:*
Contact:*
Address:*
Post Code:*
Telephone:*
Email:*
Title of Course:*
Date of Course:*
Course Overhead Expenses to be met by DOCET
Payment to lecturers / tutors
(1) Fees* £
(2) Travel and accommodation:* £
Room hire for course: £
Advertising OR local mailshot costs: £
Hire of equipment: £
Payment to patients: £
TOTAL: £
Percentage of non-optometrists attending course: %
(Please enter a number between 0 (zero) and 100)
TOTAL MINUS PERCENTAGE:* £
Actual Overheads not met by DOCET
Administrative costs: £
Refreshments: £
Other costs: ( Please Specify )
£
TOTAL: £
Revenue Received
Total attendees:
Fee charged: £
TOTAL: £
Are you applyingfor funding from other sources?
- Yes
- No
If yes, how much? £

DOCET