Churchill House, London - Wednesday 21st March 2012

To register for the meeting, please complete and submit the required information below. You will then be invited to transfer to the secure servers of WorldPay who will accept payment using the credit or debit cards shown below. You may return to this page and start again at any stage, but please do not pay more than one registration fee!

Registration Fee: £150 (£80 for Anaesthetists in Training)

(to help reduce administration and fees registration/payment is online only - if you don't have a suitable credit/debit card please ask a colleague to pay on your behalf)

DO NOT ENTER YOUR CREDIT/DEBIT CARD DETAILS ON THIS FORM

(You will be asked for this after you transfer to WorldPay's Secure server - the organisers do not receive credit/debit card details)

Please enter your name as you wish it to appear on your badge

(* denotes required field -  you MUST complete these fields)

Title (Dr/Mr/Mrs/Miss/Prof)

Firstname(s)

Surname

Job title

The following can be your hospital address/phone number  

          Address line 1

Address line 2

Address line 3

City/postcode

GMC Number (UK delegates)

This is required by the Royal College of Anaesthetists. If at all possible please enter it here; alternatively bring it with you to the meeting registration desk

Telephone

e-mail

*

(See images below)

Which device do you have in your hospital for delivery of Propofol by TCI?

(See images below)

Which device do you have in your hospital for delivery of Remifentanil?

Comments

  Change this option to accept the four terms and conditions then click submit to register. Meeting cancellations by delegates received before 1/3/12 are subject to a £25 administration charge. Refunds for cancellations after this date are discretionary.

Unselected Should the meeting be cancelled for any reason, the liability of the organisers will be limited to refund of registration fees already paid.

Unselected Subsequent implementation of all techniques discussed and/or presented at Totally TIVA is the sole responsibility of delegates.

Unselected Views expressed are those of the speakers. All dosages mentioned must be checked prior to use.

Fresenius Injectomat

Alaris Asena PK

Arcomed Anaesthesia TCI

Premium

B. Braun Space TCI

Graseby 3500

Alaris IVAC TCI

Fresenius Vial Master TCI

Graseby 3400