Registration Form

All Prices in Euros

Doctors	Super saver to 30 April 2017	Early Bird to 30 June 2017	Standard from 1 July 2017
Full conference (21-22 September)1, 2	€350	€400	€450
Day delegate 1       21 Sep       22 Sep	€180	€220	€260
Pre-Conference Workshop 1 Wednesday 20 September GAP Training       Ultrasound & Doppler	€180	€220	€260

Midwives, ultrasonographers and other professionals
Full conference (21-22 September)1, 2	€240	€270	€300
Day delegate 1       21 Sep       22 Sep	€120	€140	€160
Pre-Conference Workshop 1 Wednesday 20 September GAP Training       Ultrasound & Doppler	€120	€140	€160

¹ Includes lunch and refreshment breaks  ² Includes Welcome Reception and Gala Dinner

Additional tickets - accompanying persons	Cost	Number required
Welcome reception Wednesday 20 September	€30	0 1 2 3 4 5 6 7 8 9 10
Gala Dinner Thursday 21 September	€60	0 1 2 3 4 5 6 7 8 9 10

Your Details

Title	Please Choose Dr Miss Mr Mrs Ms Prof		Address line 1
* Title required			* Address required
First name			Address line 2
* First Name required			* Address required
Surname			Address line 3
* Last Name required
Email			City
* Email address required Please enter a valid email address			* City required
Gender	Please Choose Male Female		Postcode
* Gender required			* Postcode required
Speciality/job title			Country
* Job Title required			* Country required
Institution			Contact No.
* Institution required			* Contact No. required

Additional Comments (e.g. dietary requirements):

Preferred payment method

Please Choose Bank Transfer (BACS) Purchase Order Cheque Credit/Debit Card * Payment Method required

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