Course registration form

Venous Surgical Procedures – 26th January/ 2nd March 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.

Title*

First Name*

Last name*

Job Title*

Gender*:     

Speciality*

Name of Hospital/Organisation*

Address*:    

Postcode*

Country*

Telephone* (inc. codes)

Email*

Special Requirements*

Scanning Experience*

Particular Interest*


Please tick select your chosen topics for the course?*

Endovenous laser ablation (theatre)Foam Sclerotherapy (theatre)Alvulsions (theatre)Ultrasound imaging of veinsEVLA simulations using limb phantom

Registration Fees

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

Please note: The Early bird fee is only available if paid before the deadline. The full fee will be payable after these dates according to course availability.

Payment method

Please select payment method:

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*

   I have read and agree to the booking terms and conditions and the Privacy Notice.

   I would like to receive the Wessex Diagnostic newsletter of new developments, training courses and services.


 

Please note, if you do not receive an acknowledgement email, please check your Spam/Junk email folder and add info@wessexdiagnostic.com to your Safe senders list. If it is still not visible please contact us at info@wessexdiagnostic.com