FAST-TRACK

CHECK-IN FORM

Complete ALL sections ready to hand in at your registration.

(DO NOT POST THIS FORM)

NAME OF COURSE: MEDLINK

PATHOLOGY OPTION

NEXT STEP OPTION

(Tick if attending)

First Name:
Last Name:

Booking Ref: MLC15/

Hall: .
(As given in your Booking Confirmation)

PERSONAL REGISTRATION DETAILS

Gender: M / F (Circle)

Date of Birth:

(DD/MM/YYYY)

Home Address: ...

. Post Code: ..
Home/Contact telephone number in case of emergency: .
Mobile numbers: Delegate Parent
Email address: ..
How did you hear about this conference? .............................................................................
For your safety and in consideration of other delegates, you must read and agree to abide by the
Medlink Code of Conduct (www.medlink-uk.net/code-of-conduct). If you are under 18 years of
age your parent/guardian must add their signature to signify their permission for you to attend
Medlink.
I have read, understood and agree to abide by the Code of Conduct. I confirm I have disclosed
information on any medical or dietary condition which could compromise the delegates safety
while at Medlink.
Delegate Signature:

Parent/Guardian Signature:

....

We will from time to time send you newsletters with important information about your
conference or any of our follow-up events, including sometimes information from other
organisations or institutions that can help you with your university application. We NEVER pass
your name or details on to any other organisation.