CARBOHYDRATE COUNTING _ INSULIN DOSE ADJUSTING COURSE 2010-2011

							             CARBOHYDRATE COUNTING & INSULIN DOSE ADJUSTING COURSE
                                  2010-2011


      Name: (please print)

      Speciality: DSN/DOCTOR/OTHER - please specify:


      Address:


      Post Code:
      Daytime telephone number:

      Daytime fax number:
      Mobile number:

      Email address: (please print)


      Method of Payment:

                             £450 -- Payment required to reserve your place

      How did you hear about this course?

      I wish to attend the carbohydrate counting course at London Medical on

       rd    th
      3 & 10 November 2010      □
      13 & 20 January2011 □
        th      th


      15th & 22nd March 2011 □
        th      th
      17 & 24 October 2011     □
      (Attendance at both sessions are required)


      Signature:.…………………………………………………………………...


If you wish to attend the Course, please complete form and return to:
Yan Liu
London Medical
49 Marylebone High Street
London W1U 5HJ

By Email to:
yan.liu@londonmedical.co.uk

Telephone:
020 7467 5470

Fax:
020 7467 5471