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Risk Management Modules

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					                                                                                                     School of Informatics
                                                                                                          City University London
                                                                                                           Northampton Square
                                                                                                              London EC1V 0HB
                                                                                  T +44 (0)20 7040 8423         F +44 (0)20 7040 8585
                                                                                                                   cpd@csr.city.ac.uk
                                                                                       www.soi.city.ac.uk/pgcourses/risk-management/

Continuing Professional Development modules in
Resilience, Assurance and Risk Management for Computer-Based Systems
Please use this form for applying for a single (or group of single) CPDs only. To apply for the Postgraduate Certificate, Diploma or MSc
you are required to complete an application form for submission to the School Programmes Office - for further details please go to
http://www.soi.city.ac.uk/pgcourses/risk-management/howto-apply.html.

If you have already successfully completed three CPD modules and are applying for a fourth, you may use this form to book and pay;
however, please note that you will also be required to complete the application form required of all applicants to a Postgraduate
Certificate, Diploma or MSc course.




Please complete in BLOCK CAPITALS

1. Module details
Please tick which module(s) you are booking:

Introduction to dependability and resilience                          Software dependability and software risk management

Information security assurance and digital forensics                  Socio-technical systems, risk and resilience
Fault tolerance, redundancy and diversity: Design and                 Probabilistic modelling of dependability for computer-
analysis techniques for resilience                                    based systems

Techniques for software correctness                                   Assurance cases for IT security, safety, dependability

Module date(s):



2. Personal information
Title:                 First name(s):                                                 Surname:

Known as:                                                           Date of birth:                                         M/F

Home address:

                                                                                                Postcode:

Telephone:                                                          Mobile:

Fax:                                                                Email:



Job title:

Organisation:

Work address:

                                                                                                Postcode:

Telephone:                                                          Mobile:

Fax:                                                                Email:
3. Payment details:
All payments must be in pounds sterling. Current individual CPD module fees are available at
www.soi.city.ac.uk/pgcourses/risk-management/fees-funding.html.


       Option 1 – Please send invoice to:

Invoice name:

Invoice address (if different from work address above):

                                                                                               Postcode:

Purchase order number:


       Option 2 – Payment by debit or credit card

We accept Maestro, MasterCard, Visa and Visa Debit

Cardholder name (as shown on card):

Cardholder address (if different from work address above):

                                                                                                Postcode:


Card number                                                                                                            Issue number

                                                                                                 Security number
Expiry Date                                     Valid from date                                  (3 digits on back of card)


Card type (e.g. Visa):                                                              Total fee amount:      £

I authorise the University to charge my credit card / bank account with the above amount in respect of the fees for this course.

Cardholder signature:



4. Declaration
I agree to abide by the booking conditions set out on this form below.

Signature:                                                                                      Date:

Personal data on this form will only be used in accordance with the University’s registration under the Data Protection Act
1998. Any queries concerning Data Protection should be addressed to the University’s Data Protection Officer.

From time to time we may wish to send you information about other courses. If you do not want to receive this information,
please tick this box

Please return this form to the Executive Assistant, Centre for Software Reliability by post, fax or email – address details are
above.


BOOKING CONDITIONS
No charge is made for cancellations received at least 21 days before the start of the course. For cancellations made between 7 and 20 days
before the course, a charge of 50% of the course fee will be payable. For cancellations made less than 7 days before the course, the full
course fee will be payable. Substitutions to participants can be made without charge at any time prior to the start of the course.

We reserve the right to cancel a course and in the event of us cancelling, we will give as much notice as possible and provide a full refund of
the course fee. We will not be liable for any consequential loss.


Finance use only

Authorisation no.                                         Date                                             £
Income code: 80000CS 4141

				
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