Cochlear Hearing Implant Fitting Workshop
- GROW Level
Tuesday 21st - Wednesday 22nd May 2024
REGISTRATION FORM
MED-EL UK Office, Sheffield
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1.
I would like to attend this workshop
(Required.)
Tuesday 21st and Wednesday 22nd May 2024 - 2 days
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2.
I confirm
(Required.)
My Early Bird fee of £10 will be paid by BACS by Tuesday 26th March 2024.
Please send me the details.
My registration fee of £25 will be paid by BACS by Tuesday 9th April March 2024.
Please send me the details.
I intend to submit an abstract so my attendance is free of charge
*
3.
Title and Full Name
(Required.)
*
4.
Email
(Required.)
*
5.
Telephone
(Required.)
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6.
Position / Job Title
(Required.)
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7.
Team / Institution / Organisation
(Required.)
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8.
My key learning outcomes from the event would be?
(Required.)
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9.
If you would like themed presentations or additional topics to be delivered by guest speakers, please share your suggestions with us
(Required.)
*
10.
Please indicate if you would like to bring an informal case study for presentation to the meeting
(Required.)
Oral 15 minutes
No, not on this occasion
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11.
I would like hotel accommodation for;
(Required.)
Tuesday 21st May 2024
Not required
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12.
I would like dinner on;
(Required.)
Tuesday 21st May 2024
Not required
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13.
Please indicate if you have any special dietary requirements
(Required.)
*
14.
If you have a hearing loss, do you require any assistive equipment?
(Required.)
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15.
*Privacy Notice
The information we capture in this form will only be used in conjunction with the event or open day that you are signing up for. Once that purpose is complete, we will delete your data within 6 months.
You can view our full privacy policy here: https://www.medel.com/en-gb/privacy-policy
If you have any questions or would like your data deleted, please contact:
conferences@medel.co.uk
(Required.)
I understand the Privacy Notice
*
16.
*Consent Notice
We would love to use your photographs, videos and articles. If you are happy for us to do so please provide consent below. You can withdraw it at any time.
You can withdraw your consent at anytime by re-visiting this page.
You can view our full privacy policy here: https://www.medel.com/en-gb/privacy-policy
If you have any questions or would like your data deleted, please contact: conferences@medel.co.uk
(Required.)
Yes - I give consent. Which I may withdraw at any time.
No - I do not give my consent.
17.
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