spacer gifSociety Logo CPD Conference 2011 Booking Form

  Please complete this form and return with remittance to:
The Haemochromatosis Society, Hollybush House, Hadley Green Road, Barnet, Herts. EN5 5PR
  Name: 
  Position:
 

Organisation:
 

Address:

Postcode:
 

Telephone:
 

Email:
  Special Dietary Requirements:
 

How did you hear about the Conference?

 
  Payment
checkbox  £100 Consultants
check box  £60 Other professionals and trainees
students  £40 Nurse/Student/Other ..................................................................
Please make cheques payable to The Haemochromatosis Society
 

Signed:

Date: