Booking Form

To register, please complete this application form and return with deposit or full payment.

We shall reply confirming your place in the seminar once this payment has been received. Travel details will follow approximately 7 days before the seminar.

We intend to use the details given below to provide a CPD certificate for you.

Applicant Details
Name:
Job Title:
Hospital Address:
(Your place of work)
Hospital Telephone:
Mobile:
E-mail:
GMC Number:

NB: GMC Nor (required for CPD accreditation certificate)

Seminar Details
Seminar Title:
Dates: From:
  To:
Cost:
How did you hear about this Seminar?
       
If Other - please specify

Dietary Requirements:
Payment Details
Name & Address for Invoice
Payee contact Tel:
I understand that my place will only be confirmed when payment is made in full at time of booking.
ALL PAYMENTS ARE NON-REFUNDABLE.
I hereby agree to the terms and conditions of booking
Date:
 

Should you wish to enrol more than one person with a single payment, please submit this form then complete a new form for each applicant.

 
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