Glasgow Neuro Conference 2016

To ensure that confirmation of place is not delayed, could you kindly state if you are registering and paying for this course/event for yourself or on behalf of someone else?

I am registering and paying for myself

I am registering and paying on behalf of someone

Please provide the DETAILS OF THE STUDENT/DOCTOR on behalf of whom you are registering and paying:

Title

Gender

Forename

Surname

Address

Country

Pin code/Post code/ Zip code

Phone number (including country
code if outside the UK)

Please select whether the candidate
is a doctor or medical student.

Medical Student Foundation Year 1 & 2 Registrar / Consultant

Select your hospital

Your registration is not complete and your place in course will not be confirmed until all fields are completed.

Please provide YOUR DETAILS so that we can match the payment with the candidate's details in our system: