Royal College of Physicians of Ireland
Frederick House
19 South Frederick Street, Dublin 2
Telephone: +353 1 863 9700
Facsimile: +353 1 672 4707
Website: www.rcpi.ie
2013 Spring Conference
Friday 12 April, 2013
Practice better, better Practice Practice Updates in Occupational Health
VENUE: The Royal College of Physicians of Ireland, No.6, Kildare Street, Dublin 2
Registration Form
Name (Block Capitals)_________________________________________________________
Company / Organisation / Retired________________________________________________
Address:
_______________________________________________________________
___________________________________________________________________________
Telephone:
_______________________________________________________________
Email (required for CPD): ______________________________________________________
Registration Fee
Please tick one
Reduced Fee – Offered to Faculty Fellows, Members & Licentiates
who book before 5 April 2013,
and *who are fully paid up with their annual subscriptions
€125.00

Standard Fee – All Other Categories of Doctor
€190.00

Special Fee – Retired Faculty Fellows, Members & Licentiates, SpRs & Nurses €75.00

*As above, the reduced fee will be offered only to those Fellows, Members and Licentiates of the
Faculty of Occupational Medicine whose annual subscription fee is paid in full. Those who are not
fully paid up must pay the standard fee. To pay your annual subscription, please click here
(Ctrl+Click) or visit the RCPI website www.rcpi.ie, log into using your RCPI log in details and go to
“current enrolments” to view your subscription status and pay your fee. Alternatively you can pay
over the phone by contacting the finance department (+353 1 8639 700).
Please complete this form and return it with your cheque  to the address above.
Please make cheques payable to Faculty of Occupational Medicine.
If you would like to pay by credit card, please fill out the details below and sent by post, email
(fom@rcpi.ie ) or fax 01 672 4707.
Royal College of Physicians of Ireland
Frederick House
19 South Frederick Street, Dublin 2
Telephone: +353 1 863 9700
Facsimile: +353 1 672 4707
Website: www.rcpi.ie
CREDIT CARD DETAILS
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Visa
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