Resuscitation Council (UK)
 ALS  INSTRUCTOR  DAY
 Monday 8th December 2008 
The Royal College of Physicians
11 St Andrews Place    Regents Park    London NW1 4LE

REGISTRATION FORM
(All enquiries to: ALS@resus.org.uk)  

     PLEASE PRINT CLEARLY  
Title   
Full Name   
Address    
  
  
  
Post code   
Daytime telephone number(s)   
E-mail address   
Cheques for £85 (registration fee includes lunch and refreshments) should be made payable to the Resuscitation Council (UK) and forwarded together with this completed Registration Form to:
                                                                  The ALS Course Co-ordinator
                                                                  Resuscitation Council (UK)
                                                                  5th Floor Tavistock House North
                                                                  Tavistock Square
                                                                  London   WC1H 9HR
If you wish to pay by credit or debit card, please also complete the following section:
(Please note that we are unable to accept BACS payments)
Cardholder name and initials   
Card number 
                                       
Security number  (last 3 digits on signature strip)       
Start date        /    
Expires        /    
Issue number  (for debit cards only)     
Cardholder signature   
Date   
Please note: We cannot provide refunds for cancellations after 1 December 2008