Booking Form - Birmingham Children`s Hospital

Booking Form
Stabilisation of the Critically Ill Child Study Day
Date of course:
Hospital and Department:
Job Title:
Personal mobile:
Dietary considerations:
Course Date:
Method of Payment:
(if paying by personal cheque, please send cheque with booking form, if your trust are paying
payment must be received 7 days prior to the course date)
This course fills up very quickly please apply and sort out your payment method early.
Places will not be confirmed until payment and a booking form has been received.
Methods of payment are by cheque made payable to Birmingham Children’s Hospital NHS
FT / BCH NHS FT If your trust is funding your place then please apply early and contact the
KIDS office when you apply. This study day is intended for all health professionals within the
multidisciplinary team who are involved in the stabilisation and care of the critically ill child.
Contact: or
Birmingham Children’s Hospital
Steelhouse Lane
B4 6NH
0121 333 9687