MEETING REGISTRATION FORM
Contact Name:
first
last
Job title:
Address:
Telephone:
E-mail:
Title of Meeting:
Date:
Speakers:
Time:
Venue:
PGEA:
Yes
No
Course Fee:
Format
(tick as appropriate)
Target Audience
(tick as appropriate)
lecture
General Practitioners
panel discussion
GP Registrars
small group discussion
GP Non-principals
case studies
Hospital Doctors
practical "hands on" sessions
Community Nurses
Health Visitors
Further information:
Practice Nurses
PAMS
Pharmacists
Other
(please specify)
When you are ready, press the
Submit
button below to send in your form
Please be patient - it may take 2-3 minutes to process the information and send you a note of confirmation