Registration – 3D Rhinoplasty

Course Registration Form

Name: *

First

Last

Email: *

GMC/GDC/NMC Number: *

(If you don't have one the please enter N/A)

Designation/Grade: *

Speciality: *

Place of work: *

Address: *

Address Line 1

City

State / Province / Region

Postal Code

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Phone: *

Do you have a disability?

(Please specify)

Special dietary requirements:

Course Fees: *

Dissection Course Participant (BSRS Member) - £750.00
Dissection Course Participant (Non BSRS Member) - £900.00
Dissection Course Observer (BSRS Member) - £150.00
Dissection Course Observer (Non BSRS Member) - £300.00

Total Amount

£ 0.00

Payment: Payment for the course can be taken over the phone and details can be provided to make payment via bank transfer.

Refunds: A refund of 75% is available if notice of cancellation is received 4 weeks prior to the start of the course. No refunds will be available if cancellation request is received less than 4 weeks prior to the start of the course.

Comment or Message *

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