Order Form – to be posted or faxed

Select the course you wish to attend by clicking on it.
	MRCP Part 1	1 - 5 Dec 2008	£495
	MRCP Part 1	8 - 12 Dec 2008	£495
	MRCP Part 1	5 - 9 Jan 2009	£495
	MRCP Part 1	14 - 18 Apr 2009	£495
	MRCP Part 1	20 - 24 Apr 2009	£495
	MRCP Part 1	1 - 5 Sep 2009	£495
	MRCP Part 1	7 - 11 Sep 2009	£495
	MRCP Part 1	15 - 19 Dec 2008	£495
	MRCP Part 1	27 Apr - 1 May 2009	£495
	MRCP Part 1	24 - 28 Aug 2009	£495
	MRCP Part 2	9 - 12 Mar 2009	£400
	MRCP Part 2	6 - 9 Jul 2009	£400
	MRCP Part 2	2 - 5 Nov 2009	£400
	MRCP PACES	19 - 22 Jan 2009	£580
	MRCP PACES	26 - 29 Jan 2009	£580
	MRCP PACES	2 - 5 Feb 2009	£580
	MRCP PACES	9 - 12 Feb 2009	£580
	Final MB Medicine	Sat 28 Mar 2009	£49
	Final MB Medicine	Sun 5 Apr 2009	£49
	Final MB Surgery	Sat 18 Apr 2009	£49
	Final MB Medicine and Surgery	Sat 28 Mar & Sat 18 Apr 2009	£290
	Final MB Medicine and Surgery	Sun 5 Apr & Sat 18 Apr 2009	£290
	Final MB Medicine and Surgery	Sat 18 Apr & Sun 19 Apr 2009	£290
	Final MB Medicine and Surgery	Sat 18 Apr & Sun 19 Apr 2009	£75
	Final MB Medicine and Surgery	Sat 28 Mar & Sat 18 Apr 2009	£75
	Final MB Medicine and Surgery	Sun 5 Apr & Sat 18 Apr 2009	£75
	Final MB Medicine	Sun 19 Apr 2009	£49
Now fill in the form below and press 'Print'

Select any books you wish to order by clicking on them.
Now fill in the form below and press 'Print'

Total £0

Please enter your name and contact details
You can either fill in the details below online or print the form and then complete it by hand.

Title		* = required
Forename *
Surname *
Address 1 *
Address 2
Town/city *
County/state
Postcode/zip
Country
Email *
Phone

If buying 5 courses please write
the other 4 names below:
Forename 2
Surname 2
Forename 3
Surname 3
Forename 4
Surname 4
Forename 5
Surname 5

* Final MB candidates

If buying 5 courses write the other 4 names (first name + surname) under 'Phone' field below left.

Payment

Your place is booked once payment is received. You can pay by cheque or credit/debit card.
By cheque: Make cheque out to "Hammersmith Medicine" and write your name and address on the back. Post cheque and form to Hammersmith Medicine, 4 Mervyn Road, London, W13 9UN, UK.
By card: Print form and then enter your card details below. Post form to us (address as above) or fax it to +44 (0)20 8566 1288.

Type of card *

* = required

Name on card *

Card No *

Issue No
(if any*)

UK Maestro & Solo only

Expiry date *

MM | YYYY

Total to pay

£0

Signature *

__________________________________

Order Form – to be posted or faxed

Select the course you wish to attend by clicking on it.

Now fill in the form below and press 'Print'

Select any books you wish to order by clicking on them.

Now fill in the form below and press 'Print'

* Final MB candidates

Payment