Booking Form Stabilisation of the Critically Ill Child Study Day (ONLY 30 Places – 15 medical (Anaesthesia/ Paediatrics/ Emergency) 15 Nurses/ Others) Date: (Please specify) Name: Hospital and Department: Job Title: Email: Telephone No and address: Dietary considerations: Course Date: Method of Payment: With only 30 places 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: Rachael.boffin@bch.nhs.uk KIDS Birmingham Children’s Hospital Steelhouse Lane B4 6NH 0121 333 9687