Delegate Details
Title
Please Select
Dr
Prof
Mr
Mrs
Ms
Full Name.
*
First Name
Last Name
E-mail
*
Phone Number
-
Area Code
Phone Number
Hospital / Clinic
Position
Special Dietary Requirements
Type of Member
Member (Ordinary, Retired, Honorary, O/Seas): £175
Trainee Member: £110
Non Consultant Hospital Doctor: £110
Non-Member*: £220 (Consultant grade)
*Sponsored by
(Non-Member Only)
Events
(Events are included with registration except where stated)
Please choose
Almirall Symposium: 10.30am, Thursday, 24th September
Lunch: 12.30pm, Thursday, 24th September
IAD Autumn meeting - 2pm, Thursday, 24th September
IAD Autumn meeting Registrars' symposium 9.30am, 25th September
IAD Autumn dinner Thursday 24th September (£45 each)
1 Attending
2 Attending
3 Attending
4 Attending
5 Attending
How many will be attending
Lunch Friday 25th September
Seated
Takeaway
Sub Total
Payment
Payment Total
*
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Debit or Credit Card
Credit Card Number
Security Code
Expiration Month
January
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September
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Expiration Month
Expiration Year
2026
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2030
2031
2032
2033
2034
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2037
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2039
2040
2041
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2044
2045
Expiration Year
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