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Surname*

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Contact Information:

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Address Line 2

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Professional Information:

Job Title
AnaesthesiologistTrainee AnaesthesiologistAnaesthetic NurseIntensive Care NursePharmacistPhysiotherapistFoundation Year DoctorMedical StudentStudent NurseOther

Event Participation:

Do you have any food allergies?*
NoYes (Please specify)

Food Allergy Details

Do you have any dietary restrictions?*
NoYes (Please specify)

Dietary Restriction Details

Do you have any special requirements or require special assistance?*
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Special Requirements Details

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How You Heard (Other Details)

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Legal:

I agree to accept sole and entire responsibility for my actions and their consequences at all times, and to free the Association of Anaesthesiologists of Malta from responsibility related to such.

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