Course registration form

Vascular Ultrasound Imaging: 26 – 27th 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* (eg:dietary, disabled access, prayer room or NA for Not Applicable)

Scanning Experience*

Particular Interest*

Registration Fees

Early-bird fee + dinner (part-payment) = £450Early-bird fee only = £425


Please note after the Early-bird deadline of 5th February 2019, the full fee of £475 will be due, plus dinner if applicable


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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