Course registration form

Endovenous Surgery Course – November 14th 2018/ 6th February/ 3rd April/ 15th May 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*

GMC number*

Gender*:     

Speciality*

Name of Hospital/Organisation*

Address*:    

Postcode*

Country*

Telephone* (inc. codes)

Email*

Special Requirements*(eg:dietary, disabled access, prayer room or NA for Not Applicable)

Scanning Experience*

Particular Interest*

Registration Fees


Please note after the Early-bird deadlines the full fee will be due, provided places are still available on the course.

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.

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