Very important information

Please select NAW dates*

Please select your title*

Name*

First Last

Gender*

Job title*

Specialty*

GMC/Medical Registration Number*

Non-UK delegates please upload a valid copy of your Medical Registration

Medical defence body number

Membership of medical defence body is not essential but is desirable

Hospital*

Hospital address*

Street Address City Post Code / Zip Country

Mobile (Including country code if non-UK)*

Email*

Health declaration*

NHS employees; please provide the name of the NHS Trust from where you had your recent health clearance. Delegates not employed by the NHS or foreign delegates are required to upload a copy of their Hepatitis B immunity result with the application form.

Please state any food allergies/special dietary requirements*

Dinner & Ten Pin bowling*

Please select payment made*

Nurses/ODPs/Paramedics: If your NHS Trust/organisation will pay directly then please provide proof of your study leave and funds approval.

File Upload

Drop files here or

Max. file size: 100 MB, Max. files: 3.

Terms & conditions*

Please confirm availability of places before making a payment. Places will only become definite upon receipt of funds and application form. Refunds will only be given in the event of your cancellation within six weeks of the course. All cancellations will be subject to an administration fee of £50. The course organisers cannot accept liability for costs incurred in the event of a course having to be cancelled as a result of circumstances beyond its reasonable control, in this situation we will refund full course fee.

Northumbria Airway Workshop-NAW

Difficult Airway Management Course

(2-DAY NAW only)

ONE-DAY NAW Application Form (Nurses/ODPs only)

NAW Application Form

NAW Sponsorship form