MERSEY FRCS (ORTH) VIVA & CLINICAL COURSE

REGISTRATION FORM
(PLEASE COMPLETE AND FORWARD WITH PAYMENT)

COURSE DETAILS
Venue: Education Centre, Whiston Hospital,
Merseyside, L35 5DR
Date: Friday, 3rd and Saturday, 4th October 2014
Fee: 550
(includes registration, meals and refreshments)
PERSONAL DETAILS
Surname
First name:
Title:
Address:

Email:
Telephone:
Hospital:
GMC No:
Dietary requirement:
EXAMINATION DETAILS
Date of sitting FRCS Part 1 (MCQ):
Result of FRCS Part 1:
Date of sitting FRCS Clinical and Viva Examination:

Please note that priority for places will be given to candidates sitting the FRCS
Examination in November 2014

Cheques should be made payable to:

Wirral Orthopaedic Education Account
and forwarded together with completed registration form to: Mrs P
Palphreyman
Secretary to Mr V
Bhalaik
Arrowe Park Hospital
Arrowe Park Road
Upton
Wirral CH49 5PE