Registration

 

To register, please complete the following booking form.

Please note, your place is not confirmed until your payment is received by the Course Administrator.

 

4th Manchester Advanced Endoscopic Sinus Dissection Course

Application Form

Date: 2nd to 4th December 2019
Venue: Manchester Surgical Skills & Simulation Centre, Stopford Building, University of Manchester
Course Administrator: Mrs Natalie Whalley
 

Name of Applicant
Grade
Telephone (with code)
E-Mail:
Current Hospital
 
Applying for: Dissector - 3 days (GBP1375.00)
 
Dietary requirements
VegetarianYes
No
Other special dietary requirements
Course DinnersIncluded in fee
Message or Comments
CAPTCHA Image   Image unclear? Refresh it:
  Reload Image
Enter the code in the image above: