Surgical Simulation Course Application

Get in touch:

If you have any queries or problems with your application, please contact the team:

Email: surgicalsim@lthtr.nhs.uk
Telephone: 01257 247692.

"*" indicates required fields

Name*

Prefix First Last

Preferred badge name*

Primary Contact Number*

Alternative Contact Number

Email*

For ROBuST and Basic Practical Skills courses please use the email address connected to your RCOG Account

Indicate your profession*

Are you a Doctor/Internal Health Professional (ie. Nurses, AHP), LTHTr Foundation Doctor or External Candidate

Indicate your Grade*

If your role does not include a Grade, please state N/A

What is your Speciality?*

Please indicate your speciality if your role is not listed above*

What is your Hospital/Organisation?*

This field must be completed

Select the course that you wish to attend*

If there are no courses currently available or the dates advertised are not convenient, please select to join the waiting list and you will be contacted when new dates are available.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £170 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that to attend this course, it will cost £640 for Trainees and £700 for Consultants/SAS Doctors.

If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £300 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £170 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £170 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £275 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be sure to check that the date selected is for the correct specialism. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £625 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £685 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £350 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £300 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £300 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Select the date that you wish to attend*

Please be aware that it will cost all applicants £250 to attend this course. If the date that you wish to attend is fully booked or there are no further dates available, please contact the Surgical Simulation Team.

Please enter your RCOG/RCS Number*

If you are attending the RCOG Basic Practical Skills, RCOG ROBuST course, RCS Basic Surgical Skills course can you please provide your RCOG or RCS number. This number is required for registration purposes. If you are not attending one of these courses, please enter N/A.

Are you employed by HEENW?*

How did you hear about this course?*

Address

Street Address Address Line 2 City County Post Code Country

Please enter the address that you would like your handbooks posting to

Please specify any dietary/other requirements for face-to-face training (including allergies)*

If you require any additional support or alternative access on the day, please specify what you will need and a member of the team will contact you to discuss.

Is there any further information that we should know?*

If there is any additional information that you think that we should be aware of when processing your booking, please let us know.

Payment Confirmation*

A separate payment link will be forwarded to you, in order to secure your place please make sure that your payment is made within 2 weeks of submitting your application

I understand.

Privacy Notice - how we use your data*

Under the requirement in the General Data Protection Regulations (GDPR), we need to confirm that you have read and understood our privacy notice before you submit this form. You can find out how we use your data in the Privacy Notice available on our website here.

I understand.

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