BHS27 Manchester In-Person Registration

Internal use only

Full Name

First NameLast Name

Hospital / Organisation (this will appear on your name badge):

Email:

Tip: NHS email addresses have strong spam filters - we recommend using an alternative email address if possible. Please check your junk/spam folder to ensure safe receipt of all communications.

Mobile Tel:

What is your primary role? (select One)

Where is your primary practice / place of work? (select One)

Where did you hear about this event? (select One)

Are you registering as a Medical Student, Foundation Year Doctor or Core Trainee? Please upload evidence here (e.g. student ID/letter from your workplace)

Dietary request(s) if any?

5k The James Fountain Memorial Run (limited places) on Thursday 11th March 7am to 7.45am - I would like to register my interest to participate.

BHS and UK Hip Physio Network Session (limited places) on Thursday 11th March 8.30am to 12.45pm - I would like to register my interest to participate.

Billing Address to show on payment receipt (optional)

Street Address

Street Address Line 2

TownCounty

Postcode

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

In-Person Registration:

IN-PERSON REGISTRATION CHOICES:

Remember: the Instructional course on Friday 12th March requires separate registration (choose 'Parallel Event' option) as shown below.

Please select your category, event(s) and day(s) as appropriate.

Enter coupon

In-Person Registration:

IN-PERSON REGISTRATION CHOICES:

Remember: the Instructional course on Friday 12th March requires separate registration (choose 'Parallel Event' option) as shown below.

Please select your category, event(s) and day(s) as appropriate.*

Please select your category, event(s) and day(s) as appropriate.