Registration Respiratory Study Day Queen Alexandra Hospital Portsmouth 26/01/2018

Registration Page

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* 1. Registration
Please enter your name as it would appear on your certificate

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* 2. My email address is

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* 3. Institution ( Please note if outside Wessex and Thames Valley a fee of 30 pounds is payable-Email wonepedu@gmail.com)

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* 4. My designation is

Neonatal Nurse

Nurse Educator

Consultant Neonatologist

Consultant Paediatrician

Consultant Obstetrician

Midwife

ST1-4 Paediatrics

ST4-8 Paediatrics

Grid Neonatal Trainee

ANNP

Other (please specify)

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* 5. I want to attend this course because

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* 6. Please tick one of the following
(Please note answering this question does not preclude you in the course but allows the course coordinator to prioritize your orientation)

I have participated in simulation before and am familiar with the simnewB mannikin

I have participated in simulation before but am not familiar with high fidelity mannikins

I have never participated in simulation prior to this

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* 7. I am

Non-vegetarian

Vegetarian

Vegan

Special Requirements (please specify)

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* 1. RegistrationPlease enter your name as it would appear on your certificate

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* 2. My email address is

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* 3. Institution ( Please note if outside Wessex and Thames Valley a fee of 30 pounds is payable-Email wonepedu@gmail.com)

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* 4. My designation is

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* 5. I want to attend this course because

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* 6. Please tick one of the following(Please note answering this question does not preclude you in the course but allows the course coordinator to prioritize your orientation)

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* 7. I am

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* 8. Would You Like to Hear About Future Events and Courses via Email? (Yes/No)

* 1. Registration
Please enter your name as it would appear on your certificate

* 6. Please tick one of the following
(Please note answering this question does not preclude you in the course but allows the course coordinator to prioritize your orientation)