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P-CNS Registration

To register your interest in joining the P-CNS and also attending future Primary Care Neurology Society conferences please complete this pre-registration form. * = Required
   
Register  
Title
Surname *
Forename *
Name of your organisation
Address
 
 
 
Town
County
Post Code
Country
Telephone (daytime) *
E-mail *
Required Password *
Note: When accesssing some of the resources on this site you will be asked for your e-mail address and password.
   
Profile  
Qualifications
If you are a healthcare professional please state which profession e.g. GP, Practice Nurse, Consultant Neurologist, Physiotherapist etc:
 
If you work in the PCT offices, please indicate your job title:
 
If you work in Social Services please state your job title:
 
If you work in the voluntary sector please state name of your organisation and your position:
 
Particular neurological condition relevant to you:
Alzheimer’s Disease Epilepsy Head injury and rehabilitation
Multiple Sclerosis Stroke Motorneurone Disease
Parkinson’s Disease Pain    
   
If the neurological condition relevant to you is not listed above please provide us with the information in the following box:
Please provide details of any projects (research or otherwise) in neurology care that you are currently involved with or planned to participate in:
Current educational in neurology: e.g. GP tutor
Have you ever published research papers/articles in primary care journals on neurology?
 
If yes, please provide details:
Other Relevant information that you would like to provide the P-CNS:
   
   
I am happy for the details I have provided to be held on the P-CNS database with the understanding that no data will be released without the permission of the Executive Council. If you do not agree, please tick this box
 
From time to time we may send you additional information on the services and products of Innervate Ltd, the secretariat for the P-CNS. If you do not wish to receive information please tick this box
   
From time to time we may send you additional information on the services and products of organisations associated with P-CNS. If you do not wish to receive information please tick this box
   
 
   
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