Delegate Registration Form 2023

* REGISTRATION IS NOW CLOSED *

First Name*

Last Name*

Email*

Hospital*
—Please choose an option—Alder Hey Children’s NHS Foundation TrustBeacon HospitalBon Secours Health SystemEast Cheshire NHS TrustGalway ClinicHCA LondonHermitage ClinicLiverpool Women’s NHS Foundation TrustMater PrivateMid Cheshire Hospitals NHS Foundation TrustNew Victoria HospitalNHS DigitalNorfolk and Waveney ICSSouth Tyneside and Sunderland NHS Foundation TrustThe Clatterbridge Cancer Centre NHS Foundation TrustThe London ClinicThe Rotherham NHS Foundation TrustUniversity Hospitals of Derby and Burton NHS Foundation Trust

Ticket options* —Please choose an option—Day 1Day 2Day 1 & 2

Dinner* —Please choose an option—YesNo

Will you deliver a presentation?* —Please choose an option—YesNo
If 'Yes', please fill in details below:

Presentation duration —Please choose an option—30 min60 min

Presenter Name

Presentation Title

Presentation abstract (max 300 characters)

300

Will you enter into the presentation competition?* —Please choose an option—YesNo

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