Simulation Centre Course Booking

Course details

Course title *


Course date *


Personal details

Title *


First name *


Last name *


Position *


Ward / department *


Hospital *


Email address *


Confirm email address *


Phone number *


How did you hear about this course?


Special Requirements

Latex allergy


Special dietary needs


Special dietary needs details


Other (special requirements)


Registration Fee

    Upon receipt of your online application form, our office will contact you to organise payment.
    Please note that due to high demand places cannot be reserved until full payment has been received.

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