Clinical Training Course - Speaker Registration Form

Clinical Training Course – Speaker Registration Form

Title*
Name*
First Last
Institution / Organisation*
Address*
City Country
Email*
Mobile number (This will be used if necessary to contact you during the training)*
Accommodation
The Headquarter hotel is the Jonas Hotel, The Endcliffe Village, Endcliffe Crescent, Sheffield. Please indicate your arrival and departure date below. Your accommodation to support your attendance for the whole programme will be covered by the ECTS.
Arrival Date
DD slash MM slash YYYY
Departure Date
DD slash MM slash YYYY
- I don't need accommodation
Catering Requirements
Please let us know if you will be joining us for the neetworking dinners. You can also indicate if you have specific dietary requirements.
Networking Dinner
- Welcome Dinner 28 September
- Networking Dinner 29 September
Please state any additional requirements (including dietary requirements e.g. vegetarian)
Is there anything else we should know about your participation?
Biography
Please include below your biography (no more than 300 words). If easier, you can also use the dropbox link that was provided to you in the confirmation email.
Submit Photo
Max. file size: 256 MB.
Please include below your photograph. If easier, you can also use the dropbox link that was provided to you in the confirmation email.
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Phone
This field is for validation purposes and should be left unchanged.

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Clinical Training Course – Speaker Registration Form