2020 Southend Oral Surgery Symposium Registration Form - ESSEX LDC MEMBERS
Please fill in the form below to register for the 2020 Southend Oral Surgery Symposium
Date: Friday 5th June 2020
Time: 08:00 - 17:00
Venue: Education Centre, Southend University Hospital NHS Trust, Prittlewell Chase, Southend-on-Sea, Westcliff-on-Sea SS0 0RY

PAYMENT: Please send a bank transfer of £75.00 to the bank details below:
ACCOUNT NAME:      SOUTHEND MEDICAL POSTGRADUATE FUND
ACCOUNT NO:            90848395
SORT CODE:                20-79-73
IBAN:                           GB62 BARC 2079 7390 8483 95    
SWIFTBIC:                   BARCGB22
Reference:                   SOSS20LDC and your Surname


An email will be sent the following week to confirm receipt of your payment and secure your place at the symposium.
Email *
Email Address *
First Name *
Surname *
GDC Registration Number *
Are you a member of the Essex Local Dental Committee? *
Dietary Requirements *
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