Registration Form for Pharmaceutical Companies, Postgraduate Students, Speakers, Voluntary Sector Organisation and Other Professionals

Please select how many tickets you require below. Tickets must be booked for all persons attending.

Tick this button if you are booking for others and not attending the event

Main Group Contact

Contact Details (if not attending the event)

First Name

Last Name

Title

Organisation

Position

Email Address

Verify Email Address

Contact Telephone Number

Primary Address

Line 1

Line 2

Town/City

County

Country

Postcode

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Group Members

Group Size

Contact Details

First Name

Last Name

Title

Organisation

Email Address

Verify Email Address

Contact Telephone Number

Primary Address

Address Line 1

Line 2

Town/City

County

Country

Postcode

Dietary Requirements

Please note, your full name and dietary requirement if provided will be shared with the Jurys Inn Hinckley Island for the purpose of delivering this event.

Any special requirements?

Contact Details

First Name

Last Name

Title

Organisation (if applicable)

Position

Email Address

Verify Email Address

Contact Telephone Number

Primary Address

Address Line 1

Line 2

Town/City

County

Country

Postcode

Dietary Requirements

Please note, your full name and dietary requirement if provided will be shared with the Jurys Inn Hinckley Island for the purpose of delivering this event.

Any special requirements?

Do you require accommodation for the Conference? Please specify below:

If you require an accessible room please book this by emailing adconference@actionduchenne.org.

Thursday 10 November

Friday 11 November

Saturday 12 November

None required (or booked an accessible room via Action Duchenne events team)

Registration Form for Pharmaceutical Companies, Postgraduate Students, Speakers, Voluntary Sector Organisation and Other Professionals

Contact Details (if not attending the event)

Primary Address

Group Members

Please select the ticket type required below. This applies for the first person only, you will have the option to select the ticket types for other group members afterwards.

Contact Details

Primary Address

I agree to share my first and last name on the delegate list

Contact Details

Primary Address

I agree to share my first and last name on the delegate list

If you would like to add dinner for Friday 11th November, please select this below

Do you require accommodation for the Conference? Please specify below:

Summary

Terms and Conditions

Payment

Corporate/Student Registration Form

Registration Form for Pharmaceutical Companies, Postgraduate Students, Speakers, Voluntary Sector Organisation and Other Professionals

Contact Details (if not attending the event)

Primary Address

Group Members

Please select the ticket type required below. This applies for the first person only, you will have the option to select the ticket types for other group members afterwards.

Contact Details

Primary Address

I agree to share my first and last name on the delegate list

Contact Details

Primary Address

I agree to share my first and last name on the delegate list

If you would like to add dinner for Friday 11th November, please select this below

Do you require accommodation for the Conference? Please specify below:

Summary

Terms and Conditions

Payment