Registration

To Register online for the 3rd HIP PRESERVATION CADAVER COURSE please visit http://www.nemushealth.com/registration.


Name: ………………………………………………............................................................
Designation: ..............................................................................................................
Address: ………………………………….........................................................................
..................………………………………………………………………………………………....
City: ……………………………………………… State: ……………………………........
Country: ………………………………………………Post Code: …………………………....
Telephone: ……………………………………………
E-Mail: ………………………………………………….

Card Payment
You can ring +44 1302 322302 or +44 1302 644239 and pay by card, on the phone. We will need all the above registration details and we will confirm payment in 10 working days.
Visa/Mastercard/Maestro Card Accepted.
Fee: £ ____________  (Until 30th September 2017 -  Consultants: £595-00; Fellows/Trainees/Middle Grades: £495-00. From 1st October 2017 - Consultants: £650-00; Fellows/Trainees/Middle Grades: £550-00).
Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiry Date: __ __ / __ __ __ __
CV Code (three digit security code on the reverse of the card): __ __ __
Name on Card: ________________________________________________________

Form of Payment

Cheque enclosed, payable to ORTHOPAEDIC RESEARCH AND EDUCATION FUND
Print this page and send in your payment with cheque or card details to the address below.
SCAN AND MAIL YOUR COMPLETED FORM AND PAYMENT TO:
Carol Rosbottom, More Rehab, 138 Beckett Road, Doncaster DN2 4BA, U.K.
Tel:+44 1302 322302 or +44 1302 644239
Email: hipjointpreservation@gmail.com