BOOKING FORM

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BOOKING FORM

This form was designed for our Annual Scientific Meeting planned for 15 & 16 September 2022.

Registration form for our next Annual Scientific Meeting in 2023 will be available in early or mid next year.

You are requested to complete this form and submit to register your interest to attend the GSF Virtual Masterclass on 15 September 2022 and Virtual National ADHD Study Day on 16 September 2022.

Title *

Forename *

Surname *

Full Address *

Post Code *

Telephone Number *

Your e-mail address? *

Place of Work *

Job Title *

Information about the event on 15 and 16 September 2022

Thank you for registration for the Annual Scientific Meeting to be held on the 15th and 16th September, 2022 . The entire event is being held virtually. You can register for any one day or for both days.

The following registration fees apply.

Registration fee for;
Doctors £90 for each day. £150 for both days
Trainee doctors £70 for each day and £110 for both days
Other healthcare professionals £50 for each day; £80 for both days
Medical Representatives £40 for each day; £70 for both days
Medical and Nursing Students no registration fee.

Which Day would you like to Register for? *

Please select one.

Doctor for 15 Sep 22 (£90 for each day).

Doctor for 16 Sep 22 (£90 for each day).

Doctor for 15 and 16 Sep 22 (£150 for both days).

Trainee doctors for 15 Sep 22 (£70 for each day).

Trainee doctors for 16 Sep 22 (£70 for each day).

Trainee doctors for 15 and 16 Sep 22 (£110 for both days).

Other healthcare professionals for 15 Sep 22 (£50 for each day).

Other healthcare professionals for 16 Sep 22 (£50 for each day).

Other healthcare professionals for 15 and 16 Sep 22 (£80 for both days).

Medical Representatives for 15 Sep 22 (£40 for each day).

Medical Representatives for 16 Sep 22 (£40 for each day).

Medical Representatives for 15 and 16 Sep 22 (£70 for both days).

Medical and Nursing Students no registration fee.

What is your Total Booking fee? *

Payment Information

Please make a payment first and select one of the appropriate options from the list.

Bank transfer – Bank name: Lloyds. Account Name: George Still Forum Conference. Sort Code: 30.96.93 Account Number: 01390294. Please give your name in the reference. If you are using bank transfer facility then let us know by email.

I enclose a cheque made payable to ‘George Still Forum Conference’. Please send cheques c/o Mrs Lynda Turtill, 16 Loyd Street, Anlaby, Hull, HU10 6UG

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Payment completed? *

Yes

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