Delegate Registration Form

First Name*

Last Name*

Email*

Hospital*
---Alder Hey Children’s NHS Foundation TrustBeacon HospitalUniversity Hospitals of Derby and Burton NHS Foundation TrustCity Hospitals Sunderland NHS Foundation TrustGalway ClinicHCA LondonHermitage ClinicLiverpool Women’s NHS Foundation TrustNew Victoria HospitalNHS DigitalThe Clatterbridge Cancer Centre NHS Foundation TrustThe Countess of Chester NHS Foundation TrustThe London ClinicThe Rotherham NHS Foundation Trust

Ticket options* ---Day 1Day 2Day 1 & 2

Will attend dinner on day 1* ---YesNo

Will make a presentation* ---YesNo
If 'Yes', please fill in details below:

Part of a spotlight session ---Not a spotlight sessionSpotlight 1: InteroperabilitySpotlight 2: Bedside careSpotlight 3: MobilitySpotlight 4: eChart

Presentation duration ---30 min60 min

Presenter Name

Presentation Title

Presentation abstract (max 300 characters)

300

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