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): €200
Trainee Member: €125
Non Consultant Hospital Doctor: €125
Non-Member*: €250 (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 (€50 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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EUR
Debit or Credit Card
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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