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east midlands FRCR 2B course application form.doc
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Details Correct as of 10 January 2022

EAST MIDLANDS FRCR 2B REVISION COURSE, REPORTING COURSE AND NUCLEAR MEDICINE REVISION COURSE 09 - 11 MARCH 2022 

Surname

First Name

Gender

Male / Female

Correspondence Address

Work Address

Home Phone

Mobile No

Email address

Please indicate any special dietary requirements

Cheques to be made payable to University Hospitals of Leicester NHS Trust payment

can be made via bank transfer for these details please forward your application and

request bank details.

Please return application form with payment to:

Ms Helen Lee -Course Co-ordinator

East Midlands FRCR 2B Revision Course

Clinical Service Imaging

Leicester General Hospital

Leicester

LE5 4PW

Phone: (0116) 258 4521

E-Mail: helen.lee@uhl-tr.nhs.uk

Cancellation policy: Cancellations received more than 30 days prior to a course will receive a 75% refund of the fee paid. Cancellations received less than 30 days prior to a course will receive a 25% refund of the fee paid. Cancellations 7 days prior to the course or non-attendance will not entitle the registrant to a refund.