Course registration form

Venous Surgical Procedures – Saturday 6th April 2019

Please complete all fields to receive details of payment options via email, and note that your place can only be confirmed on receipt of the course fee.


First Name*

Last name*

Job Title*



Name of Hospital/Organisation*




Telephone* (inc. codes)


Special Requirements*

Scanning Experience*

Particular Interest*

Please tick select your preferred topics, dependent on clinic programme?*

Endovenous laser ablation (theatre)Foam Sclerotherapy (theatre)Alvulsions (theatre)EVLA simulations using limb phantomLaser Safety Certificate for an additional fee

Where did you hear about the course?*

Please state Society/ publication/ other source*    If not applicable, please enter NA

Registration Fees

Please select your chosen date and the correct rate for your profession:

Payment method

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For UK based delegates, we recommend payment by direct bank transfer. Full payment details will be emailed to you on completion of this form.

Terms and Conditions*

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