West of England Genomic Medicine Centre - Annual Event

Sandford Education Centre - Cheltenham - 1st September 2017

Many thanks for your interest in attending the West of England Genomic Medicine Centre Annual Event - in order to attend please could you fill in the details below to register your place:

*1.Please enter your full name:(Required.)

*2.Please enter your role title:(Required.)

3.In order to help us make the event a success please could you select one of the statements below which describes your background and experience with the 100,000 Genomes Programme:

Healthcare professional directly involved in the 100,000 Genomes Programme

Healthcare professional NOT currently directly involved in the 100,000 Genomes Programme

Member of the public involved in the 100,000 Genomes Programme

Member of the public NOT involved in the 100,000 Genomes Programme

Other (please specify)

4.Which, if any, of the following organisations are you employed by or associated with?

Gloucestershire Hospitals NHS Foundation Trust

North Bristol NHS Trust

Royal United Hospitals Bath NHS Foundation Trust

University Hospitals Bristol NHS Foundation Trust

Weston Area Health Trust

Other (please specify)

*5.Please provide us with your email address so we can contact you regarding this registration:(Required.)

6.If you have any dietary or access requirements that we will need to provide for in order to support your attendance please can you note them below:

7.Please let us know if there any specific topics or queries you would like us to address on the day.

Create surveys and forms with ease. Sign up free.

Privacy & Cookie Notice