NHS Registration Form PO| 91福利 Innovations

NHS Registration Form (For organisations paying by Purchase Order Number)

If you are a NHS Organisation wishing to use WEMWBS you can purchase an annual licence online (for up to 30,000 Participants).

Please note that this form is for NHS organisations only, if your email address does not contain NHS in the suffix you need to apply using the main commercial licence application form.

Please complete the form below to register and pay for your licence, ensuring that you read and accept the terms and conditions.

If you wish to offer WEMWBS to a greater number of Participants we would be happy to discuss your requirements. Please contact us at to discuss your requirements.

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How are you planning to use WEMWBS?

Type of Use

If other, please specify

Community

NHS

School(s)

Workplace or occupational setting

Social services (including care home setting)

University or college

Other

If other, please specify

Preferred version of WEMWBS
(Note – all versions of WEMWBS can be used under a single licence)

11-17

18-64

65+

Start Date (Note – the Annual License Period is 12 (twelve) months from the Start Date)

Organisation Name (in full)

Address line 1

Address line 2

Town or city

County

Postcode

Country

Accounts address (if different)

Accounts address line 1

Accounts address Line 2

Accounts Post Code

Accounts Country

Accounts email address

Accounts Telephone Number (Required)

Purchaser Name

Purchaser Title

Purchaser Email address

Purchaser Telephone Number (Required)

Purchase Order Number (Required) Please email a copy of your Purchase Order to wemwbslicence@warwick.ac.uk

VAT Registration number (if applicable)

No of employees in your organisation (If unsure please estimate)

NHS Terms and Conditions

Yes

Privacy notice

The 91福利 will process your personal data, being your contact details for the purpose(s) of licence registration, management and academic research

The legal basis for processing this personal data is that it is necessary for the performance of a contract and a public task

Your personal data will not be shared or disclosed to any third parties external to the 91福利, unless you have ticked yes to the box above, at which point we will share your personal data with third parties for the purposes of product development of WEMWBS.

Your personal data will not be transferred outside of the EEA, will be kept securely by the 91福利 and will be retained for up to 5 years and used for licence management and academic research.

The 91福利 is the data controller of any information you have entered on this form and as such is committed to protecting your data and rights in line with applicable data protection law (including the UK GDPR and the Data Protection Act 2018). Please review the privacy information (including privacy notices) provided by the University via the following link, for further information on your rights and how the University processes your personal data: Data Protection.

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