First name *
Last name *
Place of work *
Mobile Number *
Job title *
Reason for attending / what do you expect to gain? *
Do you currently prescribe exercise to your congenital heart disease patients? *
If no, please give a reason below. *
How did you hear about the Masterclass? *
Name Badge details eg. Name and Institution *
Will you require overnight accommodation? *
Will you be attending the Masterclass dinner? *
If yes, please note any dietary requirements below *
We’ll use your details to fulfill your request and your information will be added to our database. Please tick the relevant box below to say how you would prefer to be contacted (you can tick more than one box).
We promise to always keep your details safe. Occasionally, we would like to send you information about what we do and how you can support us. You are in control and if you later decide you no longer want to hear form us, you can update your records by visiting: www.heartresearch.org.uk/preference, emailing email@example.com or calling 0113 234 7474.