Course registration form

Venous Ultrasound Imaging – November 2nd 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*




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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

Registration Fees

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.

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