ATLS Booking Form

Before submitting your details via this form, please note that the information you provide will be processed by the website supplier Weebly. For information on how Weebly process your data, you can read their privacy policy. The information you provide can be accessed by Airedale NHS Foundation Trust staff with administrator accounts for the website (Clinical Skills Team, Education Centre, and Library Service) and will be used only for the purpose of responding to your comments, query or request. The details you submit may be transferred into IT systems and applications used within Airedale NHS Foundation Trust and will be password protected. Airedale NHS Foundation Trust privacy notice.

It is the responsibility as the candidate to ensure that you are fully eligible to attend this course. If we find that you aren't suitable to attend you will be withdrawn.
Doctors working overseas are not eligible to apply for the ATLS course in the UK.

* Indicates required field

Course type *

Course Dates *

Title *

Name *

First

Last

Grade *

Speciality *

Hospital/Employing Authority *

GMC No. *

RCS Reg. No. (All candidates are required to register with the Royal College of Surgeons prior to submission of the application. Please note applications submitted without this number will not be considered. This is not a full membership there are not costs involved in registering with the RCS. The account is required to be able to access the mandatory precourse online learning.) *

Preferred Contact Phone Number *

Email address *

Address (Please note your manual will be posted to this address.) *

Submit

Cancellation Policy
In the event of withdrawing from the course:
More thank 4 weeks to the course then a refund will be given with an administration fee of £30.00 charge with additional charges for any course materials provided.
If within four weeks of the date of the course then the total fee will be charged , unless in exceptional circumstances and at the discretion of Airedale NHS Foundation Trust.
Whilst we make every effort to run courses as advertised, we reserve the right to change the programme/teaching staff without prior notice and to cancel courses without liability. In the latter case a full refund will be made to participants, however Airedale NHS FT cannot be held responsible for any expenses incurred.
Please note by submitting this form you are agreeing to this policy.