application/payment form - University College London

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UCL INSTITUTE OF NEUROLOGY
QUEEN SQUARE
THE NATIONAL HOSPITAL FOR NEUROLOGY AND
NEUROSURGERY
QUEEN SQUARE
LONDON WC1N 3BG
Education Unit: Direct line: 020 3448 4460
Email: jean.reynolds@ucl.ac.uk
QUEEN SQUARE MRCP PACES NEUROLOGY COURSE
Saturday 17th May 2014
Basil Samuel Outpatients' Department, National Hospital for Neurology & Neurosurgery, London WC1
This will be an intensive one-day clinical course for candidates preparing for the MRCP Part II examination. The programme
detailed below will comprise clinical case demonstrations (in small groups) designed to prepare candidates for the PACES
examination, preceded by supporting lectures and discussion. The course will give participants the opportunity to examine
patients covering a wide range of neurological conditions. The tutors on the course are all experienced neurologists including
several consultants who have been teaching on this course for many years.
Course co-ordinators: Dr Gordon Plant, Professor Mary Reilly, Dr Matthew Evans
*Lectures: held in the Wolfson Lecture Theatre, ground floor, NHNN
Programme
8.30 am
Registration & coffee
9.00 am
Lecture on 'Cranial nerve examination' – *Wolfson Lecture Theatre
9.45am
Clinical cases
10.45 am
Coffee
11.00 am
Clinical cases
12noon
Lunch – Restaurant, Basement, NHNN (please use voucher)
1.00 pm
Lecture on 'Examination of the limbs' *Wolfson Lecture Theatre
1.30 pm
Clinical cases
3.10 pm
Tea
3.30 pm
Clinical cases
4.20 pm
Tea
4.40 pm
Clinical cases
5.30pm (approx.)
Finish
Dr Gordon Plant
Professor Mary Reilly
UCL Institute of Neurology  National Hospital for Neurology & Neurosurgery  Queen Square  London WC1N 3BG
 +44 (0)20 7692 2362  Fax: +44 (0)20 7278 5069  http://www.ucl.ac.uk/ion/
Director: Professor Michael G Hanna BSc(Hons) MBChB(Hons) MD FRCP(UK)
Institute Secretary: R P Walker BSc (Econ)
The Institute of Neurology promotes teaching and research of the highest quality in neurology and the neurosciences.
APPLICATION/PAYMENT FORM
QUEEN SQUARE MRCP PACES NEUROLOGY COURSE
Saturday 17th May 2014
Please complete and return this form to:
The Education Unit
Institute of Neurology
National Hospital for Neurology and Neurosurgery
7 Queen Square, London WC1N 3BG
Tel: 020 344 84460
Email: jean.reynolds@ucl.ac.uk
Website : www.ion.ucl.ac.uk
NAME …………………………………………………………………………………………………………….……………….…..
FULL POSTAL ADDRESS ………………………………………………………………………………………………………..…
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…………………………………………………………………………………………………..…………………………………..….
Telephone ………………………………………………Email ………………………………………………………….……………
Name & Address of Hospital ………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….……
Present Post and Speciality ……………………………………………………………………………………………………..……..
Date passed MRCP Part 1 ……………………………………………………………………………………………………….……
Date of entry to MRCP Part 11 ………………………………………………………………………………………………………
I would like to enroll for the above course and enclose a cheque for £380 made payable to ‘University College
London’. (Please note that your cheque will not be cashed until after the course has taken place)
We do NOT do bank transfers for this course.
If you wish to pay by credit card please complete the details below:
Card number:
Card Type (please tick):
Expiry Date:
Visa
Mastercard
Start Date:
Security code:
Switch/Maestro
Issue number (Switch/Maestro only):
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