Registration Form
*Please fill in this form to register your interest in attending the 14th University of Birmingham Interventional Pain Workshop due to take place this year in Nottingham on 24-26 October 2018. For further information, contact: ciaranwazir@gmail.com
Title *
Prof, Dr, Mr, Miss, etc
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Surname *
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First Name *
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Medical Speciality (incl. Pain Medicine, Anaesthesia, Neurology, Neurosurgery, etc) *
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Medical Grade (incl. Consultant Level Doctors, Fellows, Trainee Doctors) *
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Institution/Correspondence Address *
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E-mail Address *
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Contact No
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Please indicate how you would prefer to pay your registration fees: *
Please use the space below for any message you have for the organisers:
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