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Booking form

MRCOG part one Course

St Mary's Hospital, Manchester

15-17th July 2015

 I would like to book a place on the above course (please print clearly).

 

Name: ..........................................................................................................................

 

Postal address:  ............................................................................................................

......................................................................................................................................

Postcode: .......................................................................................................................

 

Place of work/ post  .........................................................................................................

 

Contact phone no:  ..........................................................................................................

 

Email address:  ................................................................................................................

 

Have you previously attempted the part one:    yes/no

 

If yes, when?  .........................................................................................................

 

Year and place of qualification:   ........................................................................................

 

Please return this form with a cheque for 390 Pounds made payable to University of Manchester to:

Anna Martin

PA to Dr C Tower

Antenatal Secretaries Office

Ground Floor

St Mary's Hospital

Oxford Road

Manchester

M13 9WL

 

Please note: a place cannot be confirmed without receipt of payment. A receipt will be sent out to confirm payment has been received and the place is reserved.

Please note: no refunds if cancelled within 2 weeks of course start date although you will be offered a place on the next course.

 

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