West Midlands Critical Care Transfer Course

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Next course - Friday 9th October 2026

Course costs: £180.

This course is supported by the West Midlands Deanery & accredited with the Royal College of Anaesthetists.

Please note we will be in touch closer to the course date to confirm if you have a space on this course and this will be subject to payment.

For further course information please go to www.critical-care-transfer-course.co.uk

Please ensure this form is fully completed.

Email *

Which course are you applying for? *

Reserve List Friday 12th June

Friday 9th October

Full name *

Your full name

Contact phone number *

GMC and Training number including deanery (if applicable) or NMC number
*

What is your grade and speciality you work within?
*

What hospital do you currently work at? *

Do you have any dietary requirements or allergies? *

How will you be paying for the course? *

I will secure my place paying by bank transfer or by card over the phone

I shall then claim the course fees back from the deanery and or my Trust

Required

Please confirm that you understand full payment must be made within 2 weeks of confirmation of place. *

Yes, I understand I must ensure full payment is made within 2 weeks of confirmation of place.

Yes, I understand and my NHS Trust are aware they are funding my place.

Required

How did you hear about this course? *

Deanery

Social media

Word of mouth

Advertised poster

Other

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report