Registration Form

1. Personal Details
Gender*   Mr Ms
Surname*
Forename*
Phone (home)
Phone (mobile)*
Email 1*
Email 2
Fields marked with asterix (*) are mandatory
2. Professional Status
Hospital*
Current Level*
Speciality*
Qualification(s)* (e.g., MRCP)
3. Have you attended a Doctors Academy event in the past?
Yes No
4. Select the course(s) you wish to teach/be involved in
  Intercollegiate Basic Surgical Skills Course
  Essential Principles and Techniques for Designing Local Flaps in Plastic Surgery
  BAPIO - Symposium on Protecting Patients and Supporting Clinicians
  Cardiff Cadaveric Ultrasound-Guided Musculoskeletal Intervention Course
  Ultrasound-Assisted Botulinum Toxin Injection for Neuromuscular Disorders in Limbs
  Intensive Revision Course for MRCS Part A exam
  Christie FRCS Exit Exam Course in General Surgery(Revision Course)
  International Medical Summer School
  World University Anatomy Challenge
  International Academic and Research Conference
  Mumbai: Intensive Revision Course for MRCS Part A Exam
  Mumbai: MRCS Part B OSCE Courses
  Dubai, UAE: Applied Basic Sciences for Postgraduate Surgical Training
  Dubai, UAE: MRCS Part B/OSCE International Course
  Clinical and Procedural Skills
  Intensive Surgical Anatomy Revision For MRCS Part B OSCE
  Manchester MRCS OSCE course (Mock exam) The Edinburgh College Course
  Cardiff MRCS OSCE course: Clinical and Procedural Skills
  Cardiff MRCS OSCE course: Applied Surgical Sciences and Critical Care
  Cardiff MRCS OSCE course: Surgical Anatomy and mock OSCE
  Cardiff MRCS OSCE course: Clinical Examination and Communication Skills
  Laparoscopic Colorectal Surgery Course & Master Class
  Diploma in Otolaryngology - Head & Neck Surgery (DOHNS): Intensive Revision Course and OSCE
  RCS Edinburgh Future Surgeons: Key Skills Course
  Clinical Anatomy as Applied to Trauma and Emergency Medicine, Whitechapel
  Surgically Applied Anatomy of Important Operative Procedures, Whitechapel
  Training the Clinical Anatomy Trainer - Level 1, Whitechapel
  Clinical Anatomy as Applied to Trauma and Emergency Medicine, Aberdeen
  Surgically Applied Anatomy of Important Operative Procedures, Aberdeen
  Training the Clinical Anatomy Trainer - Level 1, Aberdeen
  Surgical Revision for Final Year Medical Students, Manchester
  Medical Revision Course For Final Year Medical Students, Manchester
  Intensive Revision Course for MCEM Part A Exam, Manchester
  Practice Course for Clinical & Viva Examination in FRCS (Gen Surg), Wales
  Birmingham PACES course for MRCP(UK) Part2, Birmingham
  St Andrews National Surgical Conference, University of St Andrews
  National Undergraduate Paediatrics Conference, Glasgow
  HYMS National Undergraduate Surgical Conference, York
  Clinical Examination (OSCE) Practise Course For Final Year Exam, Manchester
  Clinically Oriented Anatomy for FRCS(Orth), Cardiff
  Surgical Revision for Final Year Medical Students, Cardiff
  Medical Revision Course For Final Year Medical Students, Cardiff
  Surgically Applied Anatomy Workshop for Medical Students, Cardiff
  Practice OSCE Course for Year Three Medical Students, Manchester
  Clinical Examination (OSCE) Practice Course, Cardiff
  HYMS National Undergraduate Surgical Prize Giving Evening, York Medical Society
If the course you wish to teach is not listed above, then please enter the name(s) of the course(s) that you wish to be involved in:
How often would you like to teach?
If you wish to be involved with Doctors Academy in any other capacity, please state here. Kindly provide us with as much information as possible:
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