Course *ESNEFT - Introduction to Stroke Emergency Medicine & Thrombolysis Training - 23 February 2023

Full Name *

E-Mail *

Telephone *

Workplace *

Job Role/Grade *

ESNEFT Number *

Do you have any special dietary, allergy or access requirements? *YesNo

If Yes to the above, please give details.

For marketing purposes please tell us where you heard about this course. *ICENI WebsiteJournal Printed AdJournal OnlineWord of mouthSocial MediaEmail FlyerSearch Engine i.e. Google or Bing

If you selected ‘Journal’ then please tell us which one

Do you wish to be contacted about courses and learning opportunities? *YesNo

Are you happy to be contacted for surveys and research? *YesNo