46thregistrationforum

Event Registration Form

UKFHD 46th Scientific Meeting

Conference Registration Form

Personal Info

Title

Forename

Surname

Position

Hospital /Clinic /Association

Address

Email

Phone Number

Dietary requirements - Select an option

Vegetarian Meal Non Vegetarian Meal Gluten Free

Registration Options

Please note:
To register by Email please contact Anne.Oddotte@gstt.nhs.uk
the following details by 1st May 2018:

Name
Designation
Address

Payment Info:

Select all that apply

Member Non member

Select any that apply

Training grade Doctor/Nurse Nurse Doctor

Please select payment

Payment VIA BACS

Please email Anne Oddotte for Account Number and Sort Code
Payee is UK Forum on haemoglobin disorders

Ensure your full name for work purposes is in the reference section

Credit or debit card payment can be made on the day at pre registered rate if you have registered or on the day rate if not.