Tele-education Application Form

Please complete the application form below if you would like to participate in the Paediatric Tele-education course starting September 3rd 2018. Once you have completed and submitted the form you will be redirected to the online shop where you can make payment for the course. If you would like to use an alternate method of payment such as cheque, you can just leave the shop, but we will be in touch with you to confirm your payment method.

As soon as we approve your application and payment we will send you a confirmation email and further details for accessing the E-learning site!

Personal Details
Course Details
  1. YesNoMaybe one or two
Terms & Conditions
  1. I agree to the Terms & Conditions.
Contact Permission
  1. EmailPhonePost