ONLINE BOOKING FORM FOR:

BSMDH (SCOT) SPRING SYMPOSIUM AT DUNBLANE HYDRO HOTEL

Saturday 2nd and Sunday 3rd February 2008

PLEASE COPY/PASTE AND PRINT THIS PAGE, COMPLETE AND RETURN TO:

DR H. MACKINNON, 20 BORDEN ROAD, GLASGOW, G13 1QX

Name...............................................................................................................................................................

Address  ...........................................................................................

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Tel (Home)..........................................(Work)................................................(Mobile)...................................

Email address.................................................................................................................................................

Occupation: Doctor.........      Dentist.........    Other (Specify)......................................................................

Please place tick next to your booking option(s).

Weekend rate:

(Course fee, Sat & Sun lunches & tea breaks, Society Dinner, Bed and Breakfast) = £250.........

Day Delegate fee: 

Course fee: Saturday and Sunday = £160..........

Saturday only = £60.........

Sunday only = £100.........

Saturday Society Dinner = £25.......

Accompanying guest:

Accompanying guest for Saturday night society dinner = £25........

Accompanying guest for Saturday night society dinner, and Bed & Breakfast = £65........

Attendance at Sunday Meeting = £100.......

NAME OF ACCOMPANYING GUEST.........................................................................................................

TOTAL ENCLOSED = £....................................

Please make cheque payable to “The BSMDH (Scotland)”

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For Office Use only:

Date received.......................................     Confirmation sent...........................  Payment received..........................