Registration Form

Rebirth of the Queen Mother’s 20 November 2009 Crowne Plaza Hotel Glasgow Title ...................... First Name............................................ Surname ................................................ (Block Capitals) Email Address ........................................................................... If bringing a partner please give their details below:Title ...................... First Name............................................ Surname ................................................ (Block Capitals) I would like to register to attend the event as follows:For Medical Staff

For Non-Medical Staff

Scientific Meeting and Dinner

£170

Scientific Meeting and Dinner

£100

Scientific Meeting only

£125

Scientific Meeting only

£55

Medical Trainees

£75

Anyone attending dinner only, either Medical or non Medical

£45

The evening event will begin at 7.00pm with a champagne reception, sitting down to dinner at 7.30pm prompt. Please note that the dress code is ‘Semi-Formal’, not Black Tie. Please forward this form along with your cheque for the appropriate amount, made payable to QUEEN MOTHER’S HOSPITAL LEGACY FUND, to :Patricia Steeples The Royal College of Physicians & Surgeons 232-242 St Vincent Street Glasgow G2 5RJ Cancellations before 1st October will be refunded at 50%, cancellations after this date are non-refundable