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Brian Harcourt Memorial Meeting 2009 Hazlewood Castle Paradise Lane Hazlewood Nr Leeds & York Tuesday 17th November 2009 ULTRASOUND AND IMAGING IN RETINAL DIAGNOSIS MEDICOLEGAL PITFALLS Registration: Consultants: £90.00 All other attendees: £50.00 (for registration before 30th September 2009) £60.00 (for registration after 30th September 2009) Please make cheques payable to: “The Brian Harcourt Memorial Fund” And post your cheque with this form to: Janet Nichols Secretary to Mr T R Dabbs Spire Leeds Hospital Roundhay Hall Jackson Avenue Leeds LS8 1NT Name: …………………………………………………………………………………………………………………. Grade: …………………………………………………………………………………………………………………. Base Hospital: ………………………………………………………………………………………………………. Home Address: ………………………………………………………………………………………………………. ………………………………………………………………………………………………………. Email Address: …………………………….………………………………………………………………………… Telephones: ………………………………………………………………………………………………………. Special Dietary Requirements: …………………………………………………………………………………. Signed: …………………………………………………………………………Date: ….............…………………….. |