Management Interview Skills 25th May 2016

Management Training Course 25th May 2016

Course Application Form
Department of Anaesthetics and Intensive Care and Pain Management, University Hospital of Wales, Cardiff
Full Name

Title First Name Last Name
Course Date
E-mail
Grade / Exams Passed
Place of Work
Address

Street Address

Street Address Line 2

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Area Code Phone Number
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Special Dietary Requirements

Vegetarian Lactose Intolerance Gluten Intolerance
Course Fee: £100

Early Bird Rate £80 if paid 3 weeks before course date
Please make cheques payable to 'Cardiff University' and send to:

Mrs Maria Gundy
Department of Anaesthetics, Intensive Care and Pain Medicine
3rd Floor 'B Block Main Building, University Hospital of Wales
Heath Park, Cardiff, CF14 4XW

Email: gundyma@cf.ac.uk

To enable us to confirm your place please submit and print this form and send with your payment to the address above
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