PLEASE RESERVE A PLACE ON THE 2012 INFANT HIP ULTRASOUND COURSE.
I ENCLOSE THE FEE OF £375 (THREE HUNDRED AND SEVENTY FIVE POUNDS)
Cheques payable to Hip Ultrasound Education Fund
TITLE: DR/MR/MRS/MS.................................................
SURNAME: ………………………………………………. FIRST NAME: ……………………...…
POST HELD: ………………………………………………………………………………………......
HOSPITAL: ...............................................................................................................................
ADDRESS: (for correspondence) .............................................................................................
...................................................................................................................................................
POST CODE: ............................................... TELEPHONE: ............................................
EMAIL ADDRESS: ............................................... ………………………………………….....…
HOSPITAL ADDRESS: (If different from above) ………………………………………………......
…………………………………………………………………………………………………….........
Send to: Mrs Sharon Vaughan Course Administrator 1 Winniford Close Chideock Dorset DT6 6SA
Telephone: 07816814261 (secretary) E-mail sallytscott@googlemail.com or vaughan@chideock.co.uk
|