BIRMINGHAM AND MIDLAND OBSTETRICAL AND GYNAECOLOGICAL SOCIETY

EDGBASTON STADUIM FRIDAY 28 SEPTEMBER 2012

PLEASE COMPLETE IN BLOCK CAPITALS
NAME .
.

TITLE

ADDRESS
.....................................
.....................................
......................
................
TELEPHONE . E-MAIL
..
I wish to book for the following:
Scientific Programme only
55.00

YES / NO

Members -

Trainees - 35.00
(Vegetarian Meal required):

YES / NO

My partner wishes to attend the Partners Programme

YES / NO

Partners name
..
(Vegetarian lunch required):

YES / NO

Scientific Programme & Dinner x 1

YES/NO

90.00

Scientific Programme x 1 & Dinner x 2

YES/NO

125.00

Please send my apologies

. (tick if required)

TOTAL ENCLOSED : ..
PLEASE RETURN TO :

Julia Arnold
41 Brownley Road, Shirley, Solihull,
West Midlands B90 4QP

CHEQUES TO BE MADE PAYABLE TO BMOGS