Diabetes in Scotland Conference 2010 Registration Form

Conference Registration Form

Registration Fees (an invoice will automatically be sent to you):-

Early bird discount (payment received before 23rd February 2010)	£50 plus VAT
Booking after 23rd February 2010	£75 plus VAT

Enter your details here to register for the event ( * indicates required fields)

Title * Forename * Surname *

Designation *

Organisation *

Correspondence Address:

Line 1	*
Line 2
Town/City	*
Postcode	*

Invoice Address: Tick if same

Line 1	*
Line 2
Town/City	*
Postcode	*

Telephone *

Fax

Email *

Name of Delegate attending conference

Special dietary requirements

Disabled access required?

Sound amplification required?

There are two workshop sessions. Please rank your top three preferred workshops. The organizers will make every effort to accommodate your wishes.
Workshop First Choice

Workshop Second Choice

Workshop Third Choice

I permit Diabetes UK Scotland, SIGN, The Scottish Government, NHS Scotland and ABPI to use my photograph either complete, or in part, alone or in conjunction with any wording or other pictures, for all promotional and editorial purposes. My appearance in the photograph may be used to represent an imaginary person. I understand that I do not own the copyright of the photograph.

Diabetes UK Scotland, SIGN, The Scottish Government, NHS Scotland and ABPI take data protection very seriously. We promise we will not pass your details on to other organisations. If you do not wish to receive further mailings from Diabetes UK about our work and that of our trading company, please tick here.