Postal application to attend a Doctors at Events Course

Please enter your details in the form below, then print out.
 
Course & date applied for

Name

Postal Address
Preferred contact telephone
E-mail address
Current day job Doctor
If so, what is your specialty?
Medical Student
If so, what year are you in?
Nurse
Paramedic
 Other
If you are covering events, what type are they?
Dietary requirements?


Click Print, then sign the form and attach your payment (cheques should be made payable to Doctors at Events Ltd.) along with a recent photograph, and send to:

Doctors at Events Ltd., 14 Marmion Road, Liverpool, L17 8TU
 

 

Please sign below to acknowledge that you have read and agree to be bound by the Terms & Conditions as published on the doctorsatevents.com website.


Signed: _________________________________________  Date:________________