Electronic... · Web viewCardiac Update Meetings 2017 Registration Form To register: Complete this...
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Cardiac Update Meetings 2017 Registration 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: [email protected] 2. or Post to: Arrhythmia Alliance, PO Box 3697, Stratford upon Avon, CV37 8YL 3. 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)
Transcript of Electronic... · Web viewCardiac Update Meetings 2017 Registration Form To register: Complete this...
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: [email protected]. 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
