IMMEDIATE MEDICAL CARE GENERIC CROWD DOCTOR COURSES APPLICATION FORM by hubeybrown

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									                                                      2008

         IMMEDIATE MEDICAL CARE GENERIC ‘CROWD DOCTOR’ COURSES

                                          APPLICATION FORM


Venue:         West Yorkshire Ambulance Training Centre                     Full Course Cost: £495
               Elm Bank                                                     including VAT
               Stanley Road
               Wakefield
               WF1 4LH


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

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

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

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

Contact Nos: W ……………………………………… Mobile ………………………………………………

               H ……………………………………… Email ……………………………………………….



I WILL attend IMC ‘Crowd Doctor’ Spring Course:

SUNDAY         20th JANUARY 2008(PART 1)
AND
SUNDAY         30th MARCH 2008 (PART 2)


I WILL attend the IMC ‘Crowd Doctor’ Autumn Course:

SUNDAY         28th SEPTEMBER 2008 ( PART 1)
AND
SUNDAY          21st DECEMBER 2008 (PART 2)




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


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



Please note:
A course place will only be allocated on receipt of full payment for the course. See Important Notes –
Points 1-2. – Cheques to be made payable to “The Royal College of Surgeons of Edinburgh”.

								
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