TP Tab Slide
2009 Registration form |
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| Written by Administrator | |
| Wednesday, 09 September 2009 | |
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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: ……………………………………………………………………………………………………….
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Email Address: …………………………….…………………………………………………………………………
Telephones: ……………………………………………………………………………………………………….
Special Dietary Requirements: ………………………………………………………………………………….
Signed: …………………………………………………………………………Date: ….............…………………….. |
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| Last Updated ( Friday, 11 September 2009 ) |
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