Anatomy, physiology and pathology of the eye and its clinical ...

7 downloads 148 Views 202KB Size Report
Sep 25, 2013 ... Anatomy, physiology and pathology of the eye and its clinical relevance. Wed 25th Sept 2013 – NEWCASTLE. Personal Details. First Name.
Anatomy, physiology and pathology of the eye and its clinical relevance. Wed 25th Sept 2013 – NEWCASTLE Personal Details

First Name Title

Last Name Job Type Please Select

Programme/Organisation

Programme Screener/Grader Grader Screener Senior Health Optometrist Other Screener Grader Care Manager Assistant

Address

Email Address Post Code

Telephone Number(s)

A sandwich lunch is included. Please inform us of any special dietary requirements

Please Note Numbers are strictly limited to 25 in order to allow the tutorial format to work properly – first come, first served! Budget Holder Name Has the Budget Holder agreed to fund your attendance this course? Has the Budget Holder agreed you can attend this course?

Course Details

Job Title Yes

No

Yes

No

I am a BARS member and enclose a cheque for £30 payable to BARS ltd I am not a BARS member and enclose a cheque for £60 payable to BARS ltd Please send me an invoice for £…….. . I understand that my place is not confirmed until the invoice has been paid.

Please tick as applicable.

The day will run from 10.30 until 4.15 at the Gosforth Park Hotel, High Gosforth Park · Newcastle upon Tyne, England NE3 5HN. The hotel does have parking facilities and there may be a charge, please contact the hotel for fiurther information. Public transport – good bus / rail links

Please note course fees MUST be paid in advance by Cheque which must be made payable to BARS Ltd and sent with this application form to Alison Simpson, Ophthalmology Information Manager/ Eyecare Project Manager, Department of Ophthalmology, Ward 25, Ninewells Hospital, DUNDEE. DD1 9SY. Cheques for unsuccessful applicants will be returned or destroyed. No cheques or monies will be accepted on the day. The BARS council may at any time, in their absolute discretion and without giving any reason, cancel or postpone the course, change its venue or any of the other published particulars, or withdraw any invitation to attend. The BARS council will endeavour to inform all paid up course delegates and presenters. Only monies exchanged between the course delegates and BARS LTD will be refunded. Booked and paid for travel arrangements will be at the liability of the course attendee. Please tick to indicate that you have read and agreed to these terms and conditions.