FCA 2 REFRESHER COURSE REGISTRATION FORM 2021
REFER TO WEBSITE FOR BANKING DETAILS - EMAIL YOUR PROOF OF PAYMENT TO jhbanaesthesia@gmail.com - PLEASE USE YOUR NAME + SURNAME AS THE REFERENCE
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First name *
Surname *
e-mail address *
Mobile Number *
Hospital *
Public or Private *
Obligatorio
Do you want CPD points? *
MP Number (for CPD delegates only)
Will you attend in person or virtually? *
Will you attend the full course or only certain days?
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Daily attendance rates (choose all that apply, no file included)
FILE ONLY (please note a file is included for the full course, both virtual and in person)
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Postnet branch for delivery of notes (Street address & area)
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