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Welcome
Theatre and Mediroom Conference - 21 March 2020
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Name
First Name
Last Name
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This data will be collated by a third party website. Please confirm you are happy for this to be collated?
If you are unsure or answer NO, please email Theatre.MediroomRegistration@nbt.nhs.uk and request to confirm your place via email. The data you submit on this form will be used to confirm your place for this event and will not be passed on or sold to any additional parties. Your data will be used in line with the Data Protection Act 2018 and GDPR 2016
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Email
example@example.com
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Contact Number
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What job role do you currently work in?
Healthcare Support Worker
Assistant Practitioner
Registered Nurse
Operating Department Practitioner
Student - Nurse
Student ODP
Other
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If other, please confirm what role you currently work in?
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Where do you currently work? If you are a Student, please confirm what year of study you are in.
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What specialties are you currently working/interested in?
If multiple, please tick all those that apply.
Anaesthetics
Scrub
Pre + Post Operative Care
All
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We will be providing lunch on the day. Please confirm which lunch bag you would like.
Standard Lunch Bag
Vegetarian Lunch Bag
Vegan Lunch Bag
Gluten Free Lunch Bag
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