3 Albemarle Way
London  EC1V 4RQ
Tel: 020 7490 4227
Fax: 020 7490 1269
Email: mail@qni.org.uk

Registered charity: 213128

 

Please complete this form, print it and post to:

Nursing N° 1
The Queen's Nursing Institute
3 Albemarle Way
London
EC1V 4RQ

I would like to order the Nursing N° 1 pack (containing the journal, a pedometer, T-shirt and draw-string rucksack) for £3.50

My T-shirt size
  Small

Medium

Large

Extra Large

I enclose a cheque for £3.50 made payable to the Queen's Nursing Institute.
Contact information
     Name:
  Job title:
  Email address:
 

Postal address:
    (This is my address)
  Daytime phone. no.
Professional information
  Are you:
 

A District Nurse


  A Practice Nurse
  A Nurse Partner
  A Queen's Nurse
  A Community Matron
  A Nurse Practitioner
  A Community Midwife
  A School Nurse
  A Prison Nurse
  A Health Visitor
  A Mental Health Nurse
 

Other community health practitioner
Please give details

 
 

Other
Please give details

  
 
   
 

Please add me to the email list of the Queen's Nursing Institute
 



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In accordance with the Data Protection Act 1998, the information you provide will be held in our database and used solely for the purpose of communicating with you, the registrant, and will not be shared with any third party.