Please complete the form to register online for the Event below:
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Irish Health Service Quality and Safety Conference 2008
Radisson Hotel Dublin Airport, 14 April 2008 - 15 April 2008

Registration Details

Which days do you wish to attend?   Mon 14th April (€190)   Tues 15th April (€190)   Both (€270) Do you have any specific dietary requirements? If so, please provide details Method of Payment *   Cheque   Credit Card   Invoice Purchase Order Number

Personal Details

Name Address Phone Number Email Address Organisation Job Title

Title * --- MrMrsMsMissDrFrSrProfessor First Name * Last Name * Email Address * Organisation Job Title Contact Address * Country of Residence * ---------- IrelandEnglandScotlandWalesGermanyFranceHollandAustralia Phone Number(s) (home) (work) (mobile) Fax Number

Billing Details

Same as above

Title * --- MrMrsMsMissDrFrSrProfessor First Name * Last Name * Contact Address * Country of Residence * ---------- IrelandEnglandScotlandWalesGermanyFranceHollandAustralia Phone Number(s) (home) (work) (mobile) Fax Number