Portfolio Project Registration

1. First Name *
2. Last Name *
3. Profession * DoctorNurseParamedic
4. Job Title *
5. Place of Work *
6. Health Board *
7. Professional Registration No. *
8. Address 1 *
9. Address 2 *
10. City *
11. Postcode *
12. Email *
13. Phone *
14. Mobile *

1. Cardiac Resuscitation 12345
2. Trauma Management 12345
3. Deteriorating Patient 12345
4. Paediatric Emergencies 12345
5. Maternity & Neonatal Emergencies 12345

1. Provider
2. Course
3. Date

1. Provider
2. Course
3. Date

1. Provider
2. Course
3. Date

1. Provider
2. Course
3. Date

1. Provider
2. Course
3. Date

If you would like to submit certificates or any other evidence of achievement you can do this below. Click Choose Files and select all files you would like to submit before clicking Open. This will add your selected documents to the form.

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1. We want you to know exactly how our service works and why we need your contact details. Please state that you have read and agreed to to our Privacy Policy and Terms & Conditions before you continue. * I agree to the Terms & Conditions.

1. We'd love to get in touch with you with regards to updates to your Portfolio Page, upcoming Portfolio events in your area and any other relevant Portfolio Project information. Your location and previous course history will help us determine the most suitable skills days for your area, but from time to time we may need to contact you via email, telephone or post. You can indicate how you would like us to contact you below. Please note that Email is our preferred method of contact and many of our services such as Portfolio event updates require you to check this box. EmailPhonePost