Course registration form

Vascular Ultrasound Imaging: 10-11th March 2020

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*

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Gender*:     

Speciality*

Name of Hospital/Organisation*

Address*:    

Postcode*

Country*

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Email*

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

Scanning Experience*

Particular Interest*

Where did you hear about the course?*

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

Course dinner Tuesday 10th March 2020

Registration Fees

Earlybird fee = £450

Please make your payment as soon as possible to guarantee the Early-bird reduction.

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.

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