BGS Interface Geriatrics Conference
Registration Form
When you have completed your registration form below, please proceed to the secure online payment system and make the appropriate payment.
1. Surname
2. First Name and Initials
3. Title (e.g. Prof, Dr)
4. Postal Address Line 1
5. Postal Address Line 2
6. Postal Address Line 3
7. Town
8. Post Code
9. Daytime Telephone No
10. Email address
11. Place of employment
12. Position held (e.g. SpR)
13. Special requirements (including dietary)
14. How did you hear about this event?
15. A summary of the day's findings will be available. Do you wish to receive this information?
Yes
No
16. Are you a BGS member?
Yes
No
17. Do you have objections to being contacted by the BGS or one of its partner organisations following this event?
Yes
No
18. Please indicate what registration fee you will be paying
£176.25 (medical practitioners)
£111.50 (Allied Health Professionals)
19. Do you wish to receive a receipt?
Yes
No