PLEASE NOTE THE EVENT HAS BEEN POSTPONED AND WILL NO LONGER BE TAKING PLACE ON 16TH MARCH 2011 - NEW DATE WILL BE ANNOUNCED SHORTLY.

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* 1. Are you a member of Medilink Yorkshire & Humber? (there is a fee of £65+VAT for Medilink Y&H members, and £95+VAT for non-Medilink Y&H members)

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* 2. Title

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* 3. Firstname

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* 4. Surname

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* 5. Job title / position

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* 6. Name of organisation

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* 7. Address line 1

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* 8. Address line 2

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* 9. Address line 3

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* 10. Address line 4

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* 11. Town / City

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* 12. Postcode

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* 13. Email - used for REGISTRATION CONFIRMATION

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* 14. Contact telephone

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* 15. Payment method (please select one from below)

If paying by cheque, please indicate event name/date and mark for attention of:
FAO Julia Fu
Medilink Y&H
3 Smithy Wood Drive
Chapeltown
Sheffield S35 1QN

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* 16. If by invoice, is it to be sent to the address you have provided above?

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* 17. Any special dietary requirements ie. vegetarian

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* 18. Wheelchair access needed?

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* 19. How did you find out about this event?

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