PRIME - Partnerships in International Medical Education
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PRIME Conference Application Form

Please complete the online application form below and press send to book your place.
If you prefer to register by post please download the conference booking form from the conference page.

Conference Name:

About You:

Name:

E-mail Address:

Mailing Address:

Telephone Number: including STD Code

Professional Information:

Profession or Occupation:

Please state your current level of involvement with medical education, if any?

Membership of any Christian Medical Association or similar, if any?
All PRIME teaching and training is designed to be accessible to those of any faith or none.

About the Conference:

Delegate Fee:

Please indicate payment method:
( Cheque | Online Payment | Bursary Application )

Cheques and Online Payments can only be accepted in Sterling.
Cheques should be made payable to PRIME and sent to:
PRIME, Innovation Centre, Highfield Drive, St Leonards on Sea, East Sussex. TN38 9UH
Please contact us for details of how to make payments by bank transfer for all other currency.

Accommodation:

Please contact us if you need any assistance, further information or advice regarding any of our conferences.


PRIME is a registered UK Charity. Registration Number: 1111521. Registered Office: Innovation Centre, Highfield Drive, St Leonards on Sea, East Sussex. UK. TN38 9UH.
© PRIME 2007. All Rights Reserved