BetsiCadwaladrUniversity Health Board

Therapies & Clinical Support Clinical Programme Group

North Wales Medical Physics

ALL WALES MEDICAL PHYSICS & CLINICAL ENGINEERINGSUMMER MEETING - REGISTRATION FORM9 - 10 JUNE 2011to be held at OpTIC Glyndŵr, Ffordd William Morgan, St Asaph Business Park, LL17 0JD I wish to register for the All WalesScientific Meeting(details overleaf)

Title & Full Name

Position

Hospital

Tel No

/

Fax No

Email

Thursday,9 JuneTick Box if you think you would like to attend
Workshop and Visit – Cancer Treatment Centre, Glan Clwyd
3.00 pmDemonstration Workshop: Medical Physics
Testing Diagnostic Image Display Devices
5.00 pmLinac Visit: Major Extension to North Wales Cancer
Treatment Centre – 2 new state of the art linacs

Conference DinneratFaenol Fawr Hotel- next to GlanClwydHospital(7.30 for 8.00 pm)

Pleaseinclude the options of any guests – eg if you & your guest are both having soup enter 2 in box below

Name of Dinner Guest
To Start …Insert Number
Homemade Soup of the Day served with a warm bread roll
Chilled melon with fruits and a refreshing sorbet
Homemade Chicken liver pate served with Cumberland sauce & warm toast
Main …
Chicken breast wrapped with bacon finished with pepper sauce
Grilled salmon fillet served with asparagus & hollandaise sauce
Creamy mushroom stroganoff served with rice
~ Served with potatoes vegetables of the day ~
To finish – all Homemade
Vanilla cheesecake
Sticky toffee pudding with butterscotch sauce & vanilla ice cream
Apple pie & custard
Any Special Requests:
Continued overleaf ….

North Wales Medical Physics

ALL WALES MEDICAL PHYSICS & CLINICAL ENGINEERINGSUMMER MEETING - 9 - 10 JUNE 2011
Friday 10 June – 8.45 am Registration
SCIENTIFIC SESSION at OpTIC Glyndŵr(just off A55, J26)
with EXHIBITORS, POSTERS, BUFFET LUNCH & REFRESHMENTS
DISCOUNT for Early Booking – BEFORE 5May 2011
Please indicate which event(s) you wish to book by
ticking relevant box(es) / Cost / You / Cost / Guest
Full Conference *on 9 June you can attend visitsDinner;
Thursday/Fridayon 10 June Scientific Session includes lunch / £55
Evening Dinner only on Thursday, 9 June at Faenol Fawr Hotel / £25 / £25
Scientific Session only#on Friday, 10 June at OpTIC Glyndŵr / £30
Bookings received AFTER 5 May 2011
Full Conference* to include Evening Dinner / £65
Scientific Session only#– full day with exhibition & lunch / refreshments / £40
TOTAL COSTS / £
Please make all cheques payable toBetsi Cadwaladr University Health Board and return your
Completed Registration Form (see overleaf), together with payment to:
Mrs Helen Baxandall – SecretaryEmail:
North Wales Medical Physics
Cancer Treatment CentreTel:01745 534971[or WHTN 0 1815 4971]
GlanClwydHospital Fax: 01745 445103
Bodelwyddan Denbighshire LL18 5UJ
as soon as possible please, but NO LATER THAN – 5 MAY 2011 - for DISCOUNT
Suggestions for delegates to book their own Accommodation:
Faenol Fawr [01745 591691] Special Rate B&B: £65 for double & £55 for single (off A55, J25)
Oriel House Hotel, St Asaph [01745 582716] (off A55, J27)
Premier Inn(472) Rhuddlan[0871 527 8932](off A55, J27)
Attached map showing Hospital and Hotels and Venue for Scientific Meeting
Any further information contact:Gillian Plummer01745 445100 e-mail: or
Patrick Hill01745 445108

GMP/Reg Form - AWSM 9-10 June 2011 Page 1 of 3