International Medical Summer School

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

Please select the appropriate category

Medical Student

Doctor

Title*

Gender*

Forename*

Middle Name*

Surname*

Address*

Country*

Postal code / Postcode/ PIN code /ZIP code / Area code*

Email*

Phone number* (including country code if outside the UK)

Hospital*

Year of Clinical Training

If Other

University

Year of Study

If Other

Speciality of your choice*

Day1 (Broad theme)

Days 2-5

Register for the entire Summer School - Fee: £255

Register for individual days - Fee: £60 (for each day)

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

Forename

Surname

Address

Country

Postal code / Postcode/ PIN code / ZIP code / Area code

Email

Phone number (including country code if outside the UK)

Please state your relation to this candidate