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* 1. Student Name

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* 2. Email Address

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* 3. Work Location

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* 4. Job Title

Please complete this form to choose your study day preferences for semester one (where there is a choice of dates) for academic year 2018/19. If you find nearer the time that you can no longer make the day you have chosen and you need to change it, there will be flexibility to do so.

You will book your semester two study days later in the year online. We will be opening the booking system for you to do this from late September onwards.

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* 5. Scholarship in Medical Education Day One (please select one option)

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* 6. Scholarship in Medical Education Day Two (please select one option)

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* 7. Advancing Teaching and Learning Day One (please select one option)

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* 8. Advancing Teaching and Learning Day Two (please select one option)

Thank you very much for completing this form.

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