Action on Pre-eclampsia

Study Days Enquiry Form

Thank you for your interest in our study days. The cost for the UK 2017 study days is £50 for students, and £100 for midwives and other healthcare professionals. These prices includes lunch, teas, coffees and snacks.

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Title Mr
Mrs
Ms
Miss
Dr
Rev
Prof
First name
Last name
Work title (e.g staff midwife, student, lecturer etc)
Place of work or study
Email Address
Home address line 1
Home address line 2
Home address line 3
City/County
Postcode
Telephone number
Which Study day would you like to register for? London: Wednesday September 27th 2017
Do you have any special dietary requirements eg vegetarian, coeliac, nut allergy? If so please give details below
I have downloaded the T&Cs and I agree to them
How did you hear about Action on Pre-eclampsia study days? Via APEC online newsletter ( I am on the mailing list)
Via APEC online newsletter (email forwarded to me)
Recommendation from a colleague/friend/fellow student
Poster in workplace
Poster in place of study
Email invitation from university department
Facebook
Twitter
Google search
Specific Google search
Other - please specify below
If other, please specify