19th Wessex FESS Course 2026 Registration Form Please enable JavaScript in your browser to complete this form.Name *FirstLastTitle : *Tick Appropriate Level or mention if other *Select Appropriate Level or mention if other* OtherSpR( 4, 5, 6 )SASConsultantOtherPlease SpecifySpecialty *Specialty*OtherENTNeurosurgeryOpthalmology Maxillofacial surgeryPlastic SurgeryDermatologyRight/Left-Handed *Right/Left-Handed*Right-HandedLeft-HandedAddress *Postcode *Contact Number* *Please select country codeEmergency Contact Name *Emergency Phone Number *Please select country codeEmail *Please tick any one as appropriate.I consent to share my "name and city only" with the event supporters.I consent to share my "name, city and email contact with the event supporters.I do not consent to share any of my details with the event supporters.I wish to attend the 19th Wessex Advanced Sinus Surgery Course 2026 Registration Fee: Full Dissector Fee - £1,550 (Registration fee includes tea/coffee and lunch on the course days) Cancellation policy for all new registrations :- By 28/02/2026 - Full Refund minus admin charge of £50. By 31/03/2026 – 50% refund. After 31/03/2026 – – No refund at all (for all reasons including health, visa refusal etc) unless you bring a full paying replacement delegate. Please have relevant travel/health insurance in place to cover your cancellation costs if any. Receipt of payment guarantees place.Payments should be made as a balance transfer: Account Name: Surgimed Academy Limited Account number: 94556828 Sort Code: 60-83-71 Bank: Starling Bank SWIFT/BIC: SRLGGB2L IBAN: GB19SRLG60837194556828 Disclaimer - Please put your Name & Course as reference. The signed form can be scanned and emailed to the below email address. Date Please prove you are human by selecting the car:Submit Registration Form Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.