Frcpath Mock Practical Course

FRCPath Part 2 Mock Course 21st - 22nd February 2017 Dept of Clinical Biochemistry Royal Free London NHS Foundation Trust

Title: ______

First Name: ______

Surname: ______

Hospital: ______

Address: ______

Postcode: ______

Tel: ______Fax: ______

Email: ______

Please state dietary/ disability requirements: ______

I would like to attend (please encircle): 21st 22nd Both days

I would like to attend the above course and enclose a cheque of £75/ day (London Trainees) or £200/ day (Trainees within the UK, but training outside London). See below for mode of payment

Cancellation / Refund terms and conditions:

If you cannot attend the course please ensure you inform us 1 week prior to the course date. A £20.00 charge for administrative services will be applicable Closing date for registration is 10th February 2017 Modes of payment

 Cheques are payable to : Royal Free Charity (Fund 17). Post your cheque to Dr. Nair, Department of Clinical Biochemistry, Royal Free Hospital, Pond Street, London, NW3 2QG.

 Direct to the Charity’s bank account, details of which are set out below

Account Name: ROYAL FREE CHARITY

Bank name & address: LLOYDS Hampstead Branch 40 Rosslyn Hill London NW3 1NL

Bank sort code 30-93-80 Bank account number 00279476 Account Currency GBP IBAN GB39 LOYD 3093 8000 2794 76 BIC LOYDGB21065

In all cases please quote the FUND 17 as a reference when making payment. Please email [email protected] and [email protected] after making the payment.

Royal Free Charity (Fund 17)

Post cheques to Dr Devi Nair, Dept of Clinical Biochemistry, Royal Free London NHS Foundation Trust, London NW3 2QG

Email [email protected] and [email protected]