Please register your interest in the Stabilisation of the Critically Ill Child course below.

Please note all the information you provide us is protected and will not be shared.

For any queries please contact Louise Kelly on louise.kelly14@nhs.net or ring 0121 333 9687. Thank you

What course date are you interested in?

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* 1. What course date are you interested in?

Please enter your full name

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* 2. Please enter your full name

Please provide your contact email address.

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* 3. Please provide your contact email address.

Please provide a contact number.

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* 4. Please provide a contact number.

Please enter your full address including postcode.

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* 5. Please enter your full address including postcode.

Please select your job title.

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* 6. Please select your job title.

What hospital do you currently work at?

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* 7. What hospital do you currently work at?

What speciality do you work within?

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* 8. What speciality do you work within?

Do you have any dietary requirements?

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* 9. Do you have any dietary requirements?

How will you be paying for your course?

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* 10. How will you be paying for your course?

Please confirm that you understand full payment must be made within 2 weeks of confirmation of place.

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* 11. Please confirm that you understand full payment must be made within 2 weeks of confirmation of place.

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