bulletLeeds International Cardiac MR Course

Course Intro  ::  Course contents  ::  Accomodation  ::  Pricing

IMPORTANT!!

Use this form if you want a departmental invoice for the cost of the course registration. (This form allows registration but does not allow payment to be made online.)

If you wish to pay by credit card online now, do not use this form. Instead, use our online booking facility for the course which includes online payment. This may be found at www.4chambers.com.

bulletBooking Form for Departmental Invoice

Submission of this form will automatically send your details to Margaret Green. Your email address will never be passed on or used for advertising.

Receipt of your booking will be acknowledged in due course.

Cancellation Policy: to cancel registration, you must request a refund in writing 30 days before the start of the course. Your fee will be refunded, less a 10% processing charge. No refunds can be granted for cancellation after this date. When fewer than 5 persons are registered we reserve the right to cancel the course. In this event the full registration fee will be refunded.

Course applied for:

Course Fee Options - please indicate your preference:
(Note: if you choose 5 nights accomodation, the extra night accomodation is before the first day of the course)

Profession:

MRI Experience:

Cardiac MRI Experience:

Which manufacturer do you use:

Your contact information:

Full Name:
Title:
E-mail:
Company / Institution:
Address:
Work Tel (inc. country code):
FAX:
Website?:

Other information:

Source of Funding (e.g. self, employer etc.):
What would your payment method be (MasterCard / Visa / cheque) (payment is not required now):
Any dietary Requirements (e.g. vegetarian, vegan):
Hotel Room Requirements (e.g. non-smoking):
Any other needs:
Any other questions: