Post on 24-May-2018
Cardiac Update Meetings 2017Registration Form
To register:Complete this form electronically by selecting the boxes and filling in your details (or go back to the website to download a printable version of this form)
1. Then Email to: becky@heartrhythmalliance.org2. or Post to: Arrhythmia Alliance, PO Box 3697, Stratford upon Avon, CV37 8YL3. or Fax to: +44 (0)1789 450 682
Meeting you would like to attend: Select Location
Title: Enter Title
First Name: Enter First Name Surname: Enter Surname
Job Title: Enter Job Title
Department: Enter Department
Organisation: Enter Organisation
Address: Enter Contact Address
Postcode: Enter Contact Postcode
Telephone No: Enter Telephone No Fax No: Enter Fax No
Email Address*: Enter Email Address*All correspondence will be sent via email. Please do not leave this blank.
Name as it should appear on your badge: Name for badge
How did you find out about this meeting? Click here to enter text.
Payment Details Registration Fee £17.50 (includes refreshments & lunch)
Please select your payment method below (click box to select)
☐ Credit/Debit Card: please call +44 (0)1789 867 523 to pay over the phone
☐ Cheque: Make payable to ‘Arrhythmia Alliance’. Please write delegate name(s) on back of the cheque and post to: Arrhythmia Alliance, PO Box 3697, Stratford upon Avon, CV37 8YL
☐ Invoice: For 5 or more delegates only