Registration Form (Leicester USPM)
Please fill in this form to register for 3rd International Conference on Ultrasound in Pain Medicine, Regenerative Medicine & Peripheral Neuromodulation due to take place at Leicester Race Course on 10-11 June 2023. For further information, contact: ciaranwazir@gmail.com

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Email *
Title *
Prof, Dr, Mr, Miss, etc
Surname *
Forename (First Name) *
Medical Speciality (incl. Pain Medicine, Anaesthesia, Neurology, Neurosurgery, etc)
Hospital Address/Correspondence Address *
E-mail Address *
Contact No *
Please let us know your level of experience with Ultrasound in Pain Management:
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Please use the space below for any message you have for the organisers:
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