Free for all renal trainees and renal nurses in London Nephrology and Transplantation Simulation Training Course Application Form – Wednesday, 19th September 2012 Doctors - £50 refundable deposit to reserve a place Nurses – Require a ‘guarantor’ email to reserve a place Name: ………………………………………………………………………………….……………………………. E-mail address: ………………………………………………………………………………………………….. Contact telephone no: ………………………………………………...……………………………………. Current Hospital: ………………………………………………….………………………………………….… Grade: ……………………………………………………………….…………….………………………………… Food allergies: ……………………….………………………….…………….………………………………… To book a place: send a deposit cheque (made out to ‘Guys and St Thomas’ NHS Foundation Trust’) and a completed application form to: The SaIL Centre, 1st Floor, St Thomas House, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH Please note: places are only secure once the SaIL Team have confirmed in writing availability on the course and receipt of the deposit cheque (doctor’s only) and application form. Email your queries to simulation@gstt.nhs.uk