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1. Personal Details
Title
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Gender
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Male
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Surname*
Forename*
Phone (home)
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Email 1*
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2. Professional Status
Hospital*
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Hospital within UK
Hospital outside UK
Select your hospital
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Aberdeen Royal Infirmary, Aberdeen
Addenbrooke's Hospital, Cambridge
Airedale General Hospital, Keighley
Alexandra Hospital, Redditch
Altnagelvin Area Hospital, Londonderry
Amersham Hospital, Amersham
Antrim Hospital, Antrim
Arrowe Park Hospital, Wirral
Ashford Hospital, Ashford
Ayr Hospital, Ayr
Barnet Hospital, Barnet
Barnsley District General Hospital, Barnsley
Basildon University Hospital, Basildon
Basingstoke and North Hampshire Hospital, Basingstoke
Bassetlaw District General Hospital, Worksop
Bedford Hospital, Bedford
Belfast City Hospital, Belfast
Bensham Hospital, Gateshead
Birmingham Children's Hospital, Birmingham
Birmingham Heartlands Hospital, Birmingham
Birmingham Women's Hospital, Birmingham
Bishop Auckland General Hospital, Bishop Auckland
Blackpool Victoria Hospital, Blackpool
Borders General Hospital, Melrose
Bradford Royal Infirmary, Bradford
Bridlington & District Hospital, Bridlington
Brighton General Hospital, Brighton
Bristol Eye Hospital, Bristol
Bristol General Hospital, Bristol
Bristol Haematology & Oncology Centre, Bristol
Bristol Royal Hospital for Children, Bristol
Bristol Royal Infirmary, Bristol
Bronglais General Hospital, Aberystwyth
Broomfield Hospital, Chelmsford
Buckland Hospital, Dover
Burnley General Hospital, Burnley
Calderdale Royal Hospital, Halifax
Cannock Chase Hospital, Cannock
Castle Hill Hospital, Cottingham
Causeway Hospital, Coleraine
Central Middlesex Hospital, London
Chapel Allerton Hospital, Leeds
Charing Cross Hospital, London
Chase Farm Hospital, Enfield
Chelsea and Westminster Hospital, London
Cheltenham General Hospital, Cheltenham
Chesterfield Royal Hospital, Chesterfield
Chorley & South Ribble District General Hospital, Chorley
Christie Hospital, Manchester
Churchill Hospital, Headington
City Hospital, Birmingham
Clatterbridge Centre for Oncology, Wirral
Colchester General Hospital, Colchester
Conquest Hospital, St Leonards on Sea
Corbett Hospital, Stourbridge
Countess of Chester Hospital, Chester
Craigavon Area Hospital, Craigavon
Crosshouse Hospital, Kilmarnock
Croydon University Hospital, Croydon
Cumberland Infirmary, Carlisle
Daisy Hill Hospital, Newry
Darent Valley Hospital, Dartford
Darlington Memorial Hospital, Darlington
Derriford Hospital, Plymouth
Dewsbury and District Hospital, Dewsbury
Diana, Princess of Wales Hospital, Grimsby
Doncaster Royal Infirmary, Doncaster
Dorset County Hospital, Dorchester
Downe Hospital, Downpatrick
Dr Gray's Hospital, Elgin
Dumfries and Galloway Royal Infirmary, Dumfries
Ealing Hospital, Southall
East Surrey Hospital, Redhill
Eastbourne District General Hospital, Eastbourne
Epsom General Hospital, Epsom
Erne Hospital, Enniskillen
Evelina Children's Hospital, London
Fairfield General Hospital, Bury
Falkirk & District Royal Infirmary, Falkirk
Freeman Hospital, Newcastle Upon Tyne
Frenchay Hospital, Bristol
Friarage Hospital, Northallerton
Frimley Park Hospital, Frimley
Furness General Hospital, Barrow-in-Furness
Gartnavel General Hospital, Glasgow
George Eliot Hospital, Nuneaton
Glan Clwyd District General Hospital, Rhyl
Glasgow Royal Infirmary, Glasgow
Glenfield Hospital, Leicester
Gloucestershire Royal Hospital, Gloucester
Good Hope District General Hospital, Sutton Coldfield
Goole Treatment Centre, Goole
Grantham & District Hospital, Grantham
Great Ormond Street Hospital for Children, London
Great Western Hospital, Swindon
Guest Hospital, Dudley
Guy's Hospital, London
Hairmyres Hospital, Glasgow
Halton General Hospital, Runcorn
Hammersmith Hospital, London
Harefield Hospital, Harefield
Harrogate District Hospital, Harrogate
Heart Hospital, London
Heatherwood Hospital, Ascot
Hemel Hempstead General Hospital, Hemel Hempstead
Hereford County Hospital, Hereford
Hexham General Hospital, Hexham
Hillingdon Hospital, Uxbridge
Hinchingbrooke Hospital, Huntingdon
Homerton University Hospital, London
Horton Hospital, Banbury
Hospital of St Cross, Rugby
Huddersfield Royal Infirmary, Huddersfield
Hull & East Yorkshire Women's and Children's Hospital, Hull
Hull and East Yorkshire Eye Hospital , Hull
Hull Royal Infirmary, Hull
Huntingdon NHS Treatment Centre, Huntingdon
Hurstwood Park Neurological Centre, Haywards Heath
Inverclyde Royal Hospital, Greenock
Ipswich Hospital, Ipswich
James Cook University Hospital, Middlesbrough
James Paget Hospital, Great Yarmouth
John Radcliffe Hospital, Oxford
Kent & Canterbury Hospital, Canterbury
Kent and Sussex Hospital, Tunbridge Wells
Kettering General Hospital, Kettering
Kidderminster Hospital, Kidderminster
King George Hospital, Ilford
King's College Hospital, London
King's Mill Hospital, Sutton in Ashfield
Kingston Hospital, Kingston upon Thames
Lagan Valley Hospital, Lisburn
Leeds General Infirmary, Leeds
Leicester General Hospital, Leicester
Leicester Royal Infirmary, Leicester
Leigh Infirmary, Leigh
Leighton Hospital, Crewe
Lincoln County Hospital, Lincoln
Lister Hospital, Stevenage
Liverpool Heart and Chest Hospital, Liverpool
Liverpool Women's Hospital, Liverpool
Llandudno General Hospital, Llandudno
London Chest Hospital, London
London Road Community Hospital, Derby
Louth County Hospital, Louth
Luton & Dunstable Hospital, Luton
Macclesfield District General Hospital, Macclesfield
Maidstone Hospital, Maidstone
Manchester Royal Eye Hospital, Manchester
Manchester Royal Infirmary, Manchester
Manor Hospital (Walsall), Walsall
Mater Hospital, Belfast
Medway Maritime Hospital, Gillingham
Mid-Ulster Hospital, Magherafelt
Milton Keynes General Hospital, Milton Keynes
Monklands Hospital, Airdrie
Montagu Hospital, Mexborough
Moorfields Eye Hospital, London
Morriston Hospital, Swansea
Mount Vernon Hospital, Northwood
Musgrave Park Hospital, Belfast
Musgrove Park Hospital, Taunton
National Hospital for Neurology & Neurosurgery, London
Neath Port Talbot Hospital, Port Talbot
Nevill Hall Hospital, Abergavenny
New Cross Hospital, Wolverhampton
Newcastle General Hospital, Newcastle Upon Tyne
Newham General Hospital, London
Ninewells Hospital, Dundee
Norfolk and Norwich University Hospital, Norwich
North Devon District Hospital, Barnstaple
North Manchester General Hospital, Manchester
North Middlesex University Hospital, London
North Tyneside General Hospital, North Shields
Northampton General Hospital, Northampton
Northern General Hospital, Sheffield
Northwick Park Hospital, Harrow
Nottingham City Hospital, Nottingham
Nuffield Orthopaedic Centre, Oxford
Ormskirk and District General Hospital, Ormskirk
Papworth Hospital, Cambridge
Pembury Hospital, Pembury
Perth Royal Infirmary, Perth
Peterborough City Hospital, Peterborough
Pilgrim Hospital, Boston
Pinderfields General Hospital, Wakefield
Pontefract General Infirmary, Pontefract
Poole Hospital, Poole
Prince Charles Hospital, Merthyr Tydfil
Prince Philip Hospital, Llanelli
Princess Alexandra Eye Pavilion, Edinburgh
Princess Alexandra Hospital, Harlow
Princess of Wales Hospital, Bridgend
Princess Royal Hospital, Haywards Heath
Princess Royal Hospital, Telford
Princess Royal University Hospital, Orpington
Queen Alexandra Hospital, Portsmouth
Queen Elizabeth Hospital, King's Lynn
Queen Elizabeth Hospital, Gateshead
Queen Elizabeth Hospital, London
Queen Elizabeth II Hospital, Welwyn Garden City
Queen Elizabeth Medical Centre, Birmingham
Queen Elizabeth The Queen Mother Hospital, Margate
Queen Margaret Hospital, Dunfermline
Queen Mary's Hospital, Sidcup
Queen Mary's Hospital for Children, Carshalton
Queen Victoria Hospital, East Grinstead
Queen's Hospital, Romford
Queen's Hospital (Burton), Burton-on-Trent
Queen's Medical Centre, Nottingham
Raigmore Hospital, Inverness
Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry
Rochdale Infirmary and Birch Hill Hospital, Rochdale
Rosie Hospital, Cambridge
Rotherham District General Hospital, Rotherham
Royal Aberdeen Children's Hospital, Aberdeen
Royal Albert Edward Infirmary, Wigan
Royal Alexandra Children's Hospital, Brighton
Royal Alexandra Hospital, Paisley
Royal Belfast Hospital for Sick Children, Belfast
Royal Berkshire Hospital, Reading
Royal Blackburn Hospital, Blackburn
Royal Bolton Hospital, Bolton
Royal Bournemouth Hospital, Bournemouth
Royal Brompton Hospital, London
Royal Cornwall Hospital, Truro
Royal Derby Hospital, Derby
Royal Devon & Exeter Hospital, Exeter
Royal Eye Infirmary, Plymouth
Royal Free Hospital, London
Royal Glamorgan Hospital, Llantrisant
Royal Gwent Hospital, Newport
Royal Hallamshire Hospital, Sheffield
Royal Hampshire County Hospital, Winchester
Royal Hospital for Sick Children, Edinburgh
Royal Hospital for Sick Children, Glasgow
Royal Hospitals, Belfast
Royal Infirmary of Edinburgh, Edinburgh
Royal Lancaster Infirmary, Lancaster
Royal Liverpool Children's Hospital, Liverpool
Royal Liverpool University Hospital, Liverpool
Royal London Hospital, London
Royal Manchester Children's Hospital, Manchester
Royal Marsden Hospital, Sutton
Royal Marsden Hospital, London
Royal National Hospital for Rheumatic Diseases, Bath
Royal National Orthopaedic Hospital, Stanmore
Royal National Orthopaedic Hospital, London
Royal National Throat, Nose and Ear Hospital, London
Royal Oldham Hospital, Oldham
Royal Orthopaedic Hospital, Birmingham
Royal Preston Hospital, Preston
Royal Shrewsbury Hospital, Shrewsbury
Royal Surrey County Hospital, Guildford
Royal Sussex County Hospital, Brighton
Royal United Hospital, Bath
Royal Victoria Infirmary, Newcastle Upon Tyne
Russells Hall Hospital, Dudley
Salford Royal, Salford
Salisbury District Hospital, Salisbury
Sandwell General Hospital, West Bromwich
Scarborough General Hospital, Scarborough
Scunthorpe General Hospital, Scunthorpe
Selly Oak Hospital, Birmingham
Sheffield Childrens Hospital, Sheffield
Singleton Hospital, Swansea
Solihull Hospital, Solihull
South Tyneside District Hospital, South Shields
South West London Elective Orthopaedic Centre, Epsom
Southampton General Hospital, Southampton
Southend Hospital, Westcliff-on-Sea
Southern General Hospital, Glasgow
Southlands Hospital, Shoreham by Sea
Southmead Hospital, Bristol
Southport and Formby District General Hospital, Southport
St Albans City Hospital, St Albans
St Bartholomew's Hospital, London
St George's Hospital (London), London
St Helens Hospital (Merseyside), St Helens
St Helier Hospital, Carshalton
St James's University Hospital, Leeds
St John's Hospital at Howden, Livingston
St Luke's Hospital, Huddersfield
St Luke's Hospital, Bradford
St Mary's Hospital, Manchester
St Mary's Hospital, London
St Mary's Hospital, Portsmouth
St Mary's Hospital, Newport
St Michael's Hospital, Bristol
St Michael's Hospital, Hayle
St Peter's Hospital, Chertsey
St Richard's Hospital, Chichester
St Thomas' Hospital, London
Stafford Hospital, Stafford
Stamford & Rutland Hospital, Stamford
Stepping Hill Hospital, Stockport
Stirling Royal Infirmary, Stirling
Stoke Mandeville Hospital, Aylesbury
Stracathro Hospital, Brechin
Sunderland Eye Infirmary, Sunderland
Sunderland Royal Hospital, Sunderland
Sussex Eye Hospital, Brighton
Sutton Hospital, Sutton
Tameside General Hospital, Ashton-Under-Lyne
Tickhill Road Hospital, Doncaster
Torbay District General Hospital, Torquay
Trafford General Hospital, Manchester
Tyrone County Hospital, Omagh
Ulster Hospital, Dundonald
University College Hospital, London
University Hospital, Coventry
University Hospital Aintree, Liverpool
University Hospital Lewisham, London
University Hospital Llandough, Penarth
University Hospital of Hartlepool, Hartlepool
University Hospital of North Durham, Durham
University Hospital of North Staffordshire, Stoke on Trent
University Hospital of North Tees, Stockton-on-Tees
University Hospital of Wales, Cardiff
Victoria Hospital, Kirkcaldy
Walton Centre for Neurology and Neurosurgery, Liverpool
Wansbeck General Hospital, Ashington
Warrington Hospital, Warrington
Warwick Hospital, Warwick
Watford General Hospital, Watford
West Cornwall Hospital, Penzance
West Cumberland Hospital, Whitehaven
West Middlesex University Hospital, Isleworth
West Suffolk Hospital, Bury St Edmunds
West Wales General Hospital, Carmarthen
Western Eye Hospital, London
Western General Hospital, Edinburgh
Western Infirmary, Glasgow
Westmorland General Hospital, Kendal
Weston General Hospital, Weston-super-Mare
Wexham Park Hospital, Slough
Whipps Cross University Hospital, London
Whiston Hospital, Prescot
Whiteabbey Hospital, Newtownabbey
Whittington Hospital, London
William Harvey Hospital, Ashford
Wishaw General Hospital, Wishaw
Withybush General Hospital, Haverfordwest
Woodend Hospital, Aberdeen
Worcestershire Royal Hospital, Worcester
Worthing Hospital, Worthing
Wrexham Maelor Hospital, Wrexham
Wrightington Hospital, Wigan
Wycombe Hospital, High Wycombe
Wythenshawe Hospital, Manchester
Yeovil District Hospital, Yeovil
York Hospital, York
Ysbyty Gwynedd, Bangor
Other
Aspen Healthcare
BMI Healthcare
BUPA Healthcare
HCA International
Nuffield Health
Ramsay Health Care UK
Spire Healthcare
Imperial Private Healthcare
The Grange, Cwmbran
Please enter the name of your hospital
Please enter the name of your hospital
Current Level*
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House Officer
Senior House Officer/Junior Resident
Junior Registrar (1-3 years at this grade)
Senior Registrar/Senior Resident (4-6 years at this grade)
Clinical Fellow/Staff Grade Doctor
Clinical Research Fellow
Senior Research Fellow
Consultant (<5 years at this level)
Consultant (5-15 years at this level)
Senior Consultant (<15 years at this level)
Basic Scientist
Post-Doctoral Fellow
Lecturer
Senior Lecturer
Reader
Clinical Academic
Professor
Speciality*
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Accident and Emergency
Anaesthesia
Anatomy
Biochemistry
Burns
Cardiology
Cardiothoracic surgery
Critical Care
Dental Surgery
Endocrinology
Fertility Medicine
Gastrointestinal Medicine
General Medicine
General Practice
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Infectious Diseases
Intensive Care
Microbiology
Nephrology
Neuro Surgery
Neurology
Obstetrics and Gynaecology
Oncology
Ophthalmology
Oral Maxillofacial Surgery
Orthopaedic Surgery
Oto-rhino-laryngology
Paediatric Surgery
Paediatrics
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Physiology
Plastic Surgery
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Qualification(s)* (e.g., MRCP)
3. Have you attended a Doctors Academy event in the past?
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