The Wonder of Childhood (Part 1)

(Aimed at Medical Students and Foundation Year Doctors)

10^th February 2021

Registration Form

I am a

Medical Student

Doctor

Dental/Science Student

Title

Gender

Date of Birth The Royal College of Surgeons of Edinburgh requests your date of birth in order to provide you access to the pre-course material/videos.

Please ensure that you enter your name accurately since it will be printed on your certificate.

Enter your first name E.g., Anthony Mathew Jones (first name in red)

Enter any middle name(s) E.g., AnthonyMathew Jones (middle name in red)

Enter your surname E.g., Anthony MathewJones (last name in red)

Address

Pin code/Post code/ Zip code

Landline Number

Mobile Number

Twitter

All future correspondence regarding the course will be sent via email. Hence please ensure that you provide the one(s) you check regularly.

Your Professional Status

Please state your university/hospital

Please state if you are undergraduate/postgraduate student or working professional

Hospital

Current Affiliation

University

Year of Study

Please select whether you are a Doctor or Medical Student.

Need Help?

Please email us at contact@doctorsacademy.org.uk if you experience any difficulties during the registration or payment process. One of our support staff will get in touch with you immediately.
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