Brian Harcourt Memorial Meeting

2009

Hazlewood Castle Paradise Lane Hazlewood Nr Leeds & York

Tuesday 17^th November 2009

ULTRASOUND AND IMAGING IN RETINAL DIAGNOSIS

MEDICOLEGAL PITFALLS

Registration:

Consultants: £90.00

All other attendees: £50.00 (for registration before 30^th September 2009)

£60.00 (for registration after 30^th 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: ….............……………………..