Application form
Please fill in the application form if you wish to attend the course
Course Information
Dates 16 December 2017    |   17 December 2017   
Venue The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE
Fee £199 per course
Step 1Application Information
Applying for
Will you be bringing a friend?
(£10 discount each for 2 people applying
together for the same course)
If Yes, please provide their full name
Are you a member of:
If Yes, membership number
Step 2Personal Information
Title
Name
Address
Telephone Email
Step 3Training Information
GMC Number
Medical School Year of Graduation
Highest Qualification
Training Level / Speciality
Current Hospital
Name of Foundation School, Deanery/EducaIonBoard
Step 4 Other Information
Special Requirements
Where did you hear about the course?
Step 5Payment

Thank you for completing the application form. The course text book is included in the price and will be posted to you by CUP to your address. We usually confirm your place by email within 48 hours once the payment has been processed.

One Person Plus Friend FREE textbook RRP £37.99
BBiOrth course only – 1 day

FRCS VIVA course only – 1 day

BBiOrth & FRCS VIVA courses - 2 days

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