2012 REFRESHER Update Course application by 30oFP3

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									                                                    2012
Refresher and Skills Update and Reassessment and Recertification Immediate
                     Medical Care ‘Crowd Doctor’ Course
                                     For Existing ‘Crowd Doctors’

                                            RESPONSE FORM


Course dates: Saturday 31st March and Sunday 1st April 2012 It is intended that the
course will be held in the North - Leeds Area. (venue to be confirmed).
Venue:           Leeds Area

Full Course Cost:            £325.00 includes VAT



Name: Please Print: ………………………………………………………………………………….....................

Contact Address: …………………………………………………………………………………………………….
(inc. Postcode)
…………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………..............

……………………………………………………………………….Postcode………………………

Contact Nos:       W ……………………………………… Mobile ………………………………………………
                   H ……………………………………… Email ……………………………………………….



I WILL attend the REFRESHER & SKILLS UPDATE
‘Crowd Doctor’ Course on:Saturday 31st March and Sunday 1st April 2012


I enclose payment by cheque of £325.00 payable to
‘Hill Square Education Trust’ Royal College of Surgeons of Edinburgh.’




This form, together with payment of £325.00 should be returned at your earliest opportunity to
Ms.L.Millar, Faculty of Pre-hospital Care RCS (Edin.), Nicolson Street, Edinburgh, EH8 9DW

Signed: ………………………………………………………Date: ………………………………...


Please Print Name
……………………………………………………………………………………………………...

Please note: A course place will only be allocated on receipt of full payment for the course.

								
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