Hands-on Surgical & Ward Skills Course

for Maxillofacial SHOs

Derriford Hospital, Plymouth

25-26^th January 2007

 

Title:                         ……………  (Dr/Mr/Mrs/Other)

 

Full Name:             …………………………………………………………………………..

 

Address for correspondence:

 

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E-mail address: …………………………………………………………………………

 

Telephone (work)  ………………………  Telephone (home)  ………………………..

 

Present post held:

 

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Place of work:

 

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Please send details of suggested accommodation                                                              ٱ               

 

 

If vegetarian, please tick box                                                                                                                    ٱ

 

Full payment of course fee (£195) must be included with the application form to secure a place.  Please make cheques payable to the Plymouth Hospitals NHS Trust.

 

Please return the completed application form and cheque to:

 

Miss Pam Morris Course Administrator Maxillofacial Department Level 07 Derriford Hospital Derriford Road Plymouth PL6 8DH

If any queries, please contact on: e-mail:  pam.morris@phnt.swest.nhs.uk Telephone: 01752  517637 Fax:  01752  763212