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Stockport SAS Doctors
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5th Stockport Ultrasound Regional Anaesthesia Workshop Booking Form
Course / Workshop Name
Stockport ultrasound regional anaesthesia workshop for CT11 / CT2 Trainees
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Please choose the course name
Booking date
Title
Mr
Miss
Mrs
Ms
Dr
Other
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If you selected other please enter in the next box
Other Title
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If the title is not available then please enter in this box
First Name
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Please enter your first name
Last Name
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Please enter your lastname
PLEASE PUT YOUR CONTACTABLE EMAIL ADDRESS.
PLEASE ADD admin@sasdoctors.co.uk & sas@stockport.nhs.uk to safe sender list as the email will come from this email address.
Please don't put your hospital or department number. Supply a number which we can contact easily or leave a message.
Email
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PLEASE PUT YOUR CONTACTABLE EMAIL ADDRESS. PLEASE ADD admin@sasdoctors.co.uk & sas@stockport.nhs.uk to safe sender list as the email will come from this email address
Contactable phone number
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Please don't put your hospital or department number a phone number which we can contact
GMC OR COLLEGE NO
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PLEASE ENTER YOUR GMC/COLLEGE NO
Speciality
Accident & Emergency
Acute Medicine
Anaesthetics
Breast Care
Breast Surgery
Cardiology
Cardiothoracic surgery
Cardiothoracic Transplant
Cellular Pathology
Chemical Pathology
Community Health
Community Paediatrics
DMOP
DMOP/ Care of the elderly
Emergency Medicine
Emergency Medicine / A & E
Endocrinology
ENT
Gastroenterology
General Surgery
GUM
ICU & Anaesthesia
Immunisation & Vaccination
Infection Prevention & Control
Intestinal Failure
Medicine
Neonatology
Obstetrics & Gynaecology
Ophthalmology
Oral & Maxillofacial Surgery
Orthogeriatrics
Paediatrics
Plastic Surgery
Psychiatry
Radiology
Rehabilitation Medicine
Renal medicine
RENAL TRANSPLANT SURGERY
Respiratory Medicine
Resuscitation & Simulation
Rheumatology
Sexual Health
Sexual Health & Family Planning
Trauma & Orthopaedics
Urology
Vascular Surgery
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Your Speciality if it is not available please choose the nearest one. Gastroenterology you could choose Medicine or Surgery if you are part of surgical gastroenterology.
HospitalName
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Hospital Name please
Address including post code
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Address including post code
Current Post
Associate Specialist
Consultant
CT1-2
Hosp Practitioner
Junior Clinical Fellow
Locum Registrar
Not Avaialable
Nurse Consultant
Research fellow
SAS Doctor
Senior Clinical Fellow
Speciality Registrar
Speciality Registrar
Specialty Doctor
Staff Grade
Trust Grade Doctor
Trust Registrar
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Please select your current post
We will try and cater to the majority of dietary requirements. However we cannot cater for every individual needs. Please type in your requirements below
Dietary requirements
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We will try and cater to the majority of dietary requirements. However we cannot cater every individual needs. Please type in your requirements.
Fee For Course
I will send £40 cheque payable to Stockport NHS Foundation Trust as a payment.
I will pay £40 by credit card. (Please ring Angela Berry on 01614194097)
Click here to access and read the terms and conditions. Please read this carefully before ticking the next box. A tick in the box confirms that you have read and understood, will comply with the terms and conditions.
Terms & Conditions
I have read and understood the terms and conditions.