Registration Form: Course 23-27th June 2025

Applications open: October 1, 2024
All Fields (*) must be completed for acceptance.

*Surname :

*Firstname :

Preferred Name :

Hospital :

*Mobile / Phone :

Email :

NB:  Server generated emails may be filtered as SPAM.
Please check your SPAM/Junk folder and allow 10-15 minutes for the registration email to appear.

*State / NZ :

Faculty :

Dietery Requirements :

Emergency Contact :

Contact Mbl/Ph :

Afternoon viva sessions(*) - candidates can elect to attend either trial vivas, simulating the examination process, or small group tutorials:

I understand that my position on the course is based upon clearance of payment by EFT or through PayPal and that the order of clearance determines placement:    Accepted.

If you wish to pay via PayPal, please check here:

A Link to PayPal will be provided on submission.