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Registration Form

Online seminar: Module 3 – Pain and the Brain
Sunday, 16th January 2022; 9:00am – 5.30pm (GMT)

Registration Fee: £125 (GBP) / €150 (EUR)

Name *

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Last

Email *

Preferred payment method

Credit/debit card (payment in UK Pounds or Euros)

Please select preferred payment currency

UK Pound Sterling (GBP)
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Do you require an attendance certificate (sent by email after the seminar)?

Yes
No

If you have attended an online seminar with us before, you do not need to fill out the billing details below (unless they have changed).

I have attended an online module with Neuroseminars before.
This is my first online module.

Business Name (if applicable)

Business Number, VAT Number, NIF or CIF (if applicable)

Billing Address

Telephone number

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