2020 Southend Oral Surgery Symposium Registration Form
Please fill in the form below to register for the 2020 Southend Oral Surgery Symposium
Date: Friday 4th June 2021
Time: 08:00 - 17:00
Venue: Education Centre, Southend University Hospital NHS Trust, Prittlewell Chase, Southend-on-Sea, Westcliff-on-Sea SS0 0RY

PAYMENT: Please send a bank transfer of £100.00 to the bank details below:
ACCOUNT NAME:      SOUTHEND MEDICAL POSTGRADUATE FUND
ACCOUNT NO:            90848395
SORT CODE:                20-79-73
IBAN:                           GB62 BARC 2079 7390 8483 95    
SWIFTBIC:                   BARCGB22
Reference:                   SOSS2020 and your full name


An email will be sent the following week to confirm receipt of your payment and secure your place at the symposium.
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First Name *
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GMC / GDC Registration Number *
For dental students, please place 000000
Dietary Requirements *
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