Course *LAPCO TRAIN THE TRAINER
Full Name *
E-Mail *
Telephone *
Workplace *
Are you a Consultant? *
Please summarise the extent of your current training activity *
Please summarise your laparoscopic colorectal activity *
What level surgical trainees do you train? *
Please detail any further information relevant to the training you provide *
Do you have any special dietary, allergy or access requirements? *YesNo
If Yes to the above, please give details.
As a hotel guest I will accept full responsibility for any issue/damage that is not of the fault of the hotel *I Agree
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