NSUKI ASM ONLINE REGISTRATION
*Please complete this form to register for the Neuromodulation Society of the United Kingdom & Ireland's Annual Scientific Meeting, a Joint Congress with the Canadian Neuromodulation Society, due to take place at Radisson Blu Royal Hotel, Dublin, Ireland on 3-5 October 2024.  For further info on the ASM, email: ciaranwazir@gmail.com  or visit: www.nsukiasm.com
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Email *
Title
Forename *
Surname *
Medical Speciality *
Hospital/Clinic/Company Address *
E-mail Address *
Contact No *
Please let us know how you would like to pay your registration fee: *
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Please let us know whether you would like to submit an abstract for the free oral presentations and poster presentations at the congress: *
Please let us know whether you would like to attend the Congress ASM Dinner at the historic Dublin City Hall on 04.10.24 for additional sum of £75/person: *
Please advise whether you have any dietary requirements for the Congress catering: *
Please include any message for the organisers below:
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