UCL INSTITUTE OF NEUROLOGY
QUEEN SQUARE
LONDON WC1N 3BG
REGISTRATION FORM
Please complete and return this form
by email to: skaaro3@ucl.ac.uk
Payment via online booking must be made before your place is confirmed:
(http://onlinestore.ucl.ac.uk/browse/extra_info.asp?compid=1&modid=2&
deptid=125&catid=178&prodid=1315)
a) PLEASE WRITE IN CAPITAL LETTERS:
FIRST NAME
SURNAME
FULL POSTAL
ADDRESS
TELEPHONE/MOBILE
EMAIL
PLEASE TICK APPROPRIATE BOX:
b) Registration Fees: (fee includes Lectures and Workshop)
Consultants
£600 for full course (4 days) 
Registrars/Trainees/Residents/Postdocs
£500 for full course (4 days) 
Full Time Students (BSc/MSc/PhD)
£250 for full course (4 days) 
Payment via online booking must be made before your place is confirmed:
(http://onlinestore.ucl.ac.uk/browse/extra_info.asp?compid=1&modid=2&
deptid=125&catid=178&prodid=1315)
Cancellation policy: Cancellations within 7 days of initial booking can be refunded in full. After 7 days until 27 March
80% can be refunded. After 27 March 2016 there will be no refunds.