Registration Form

Please complete the form below to register your interest. Then, make your cheque for £150.00 payable to ‘The Manchester Sinus Education Fund’ and send it to the Course Administrator:

Mrs Natalie Whalley
Department of Otolaryngology – Head & Neck Surgery
Manchester Royal Infirmary
Oxford Road
Manchester M13 9WL

e-mail: natalie.whalley@cmft.nhs.uk

Phone: 0161 276 5975

Cancellation

Cancellations received in writing before 6 weeks of the first day of the event will be entitled to a 70% refund. After this date, refunds CANNOT be given unless a like-for-like replacement can be found. Bookings may be transferred to a colleague provided that details are submitted, in writing, to the organisers by no later than the first day of the event.

1st Royal Society of Medicine Trainees’ Sinus Dissection Day

Manchester, Friday 10th June 2016

Venue: Manchester Surgical Skills & Simulation Centre, Stopford Building, University of Manchester

Course Administrator: Mrs Natalie Whalley

 

Name
RSM Membership Number
Grade	Select ST3 ST4 ST5 ST6 ST7 ST8
Telephone (with code)
E-Mail:
Current Hospital
Dietary requirements
Vegetarian	Yes No
Other dietary requirements
Supporting Statement for Application (not more than 150 words)
Refresh Image Enter the code in the image in this space
Incorrect code Please enter the correct code as seen in the image above