Invite & Registration: HHT Ireland Patient Forum 2019
Event Timing: 10am - 3.30pm, 23rd March 2019
Event Location: Maldron Hotel, Portlaoise. Co Laois
Contact HHT Ireland at (083) 4222302 for any queries
I hereby agree that HHT Ireland can use my contact details for HHT Ireland purposes only.
Name *
Your answer
Surname *
Your answer
Street Name *
Your answer
Town *
Your answer
County *
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Email
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Phone No *
Your answer
Do you have HHT
If Yes, please tick relevant boxes
Details of any accompanying minors, if any (Total & ages) *
Required
Names of any accompanying adults - state "NONE" if appropriate *
Your answer
Dietary Restrictions (Light Lunch) *
Required
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