APPLICATION FORM
West Midlands Newborn Networks Neonatal Update Study Day
Hot topics in neonatal care
Thursday 27thSeptember 2012 9a.m. - 4.00 pm
Please complete this form prior to the course, and return it, either by post or email toTeresa Meredith, Executive Assistant, Newborn Network,
3rd Floor, Friars Gate,
Stratford Road,
Solihull B90 4BN.
Telephone Enquiries : 0121 746 4457
Email :
Places are limited so please book early. This event is FREE to staff who work in the West Midlands Newborn Networks (SWMNN or SSBCNN). There is a nominal charge of £10 for external staff. External candidates please understand that we will not be able to confirm your place unless a cheque has been received. Cheques should be made payable to ‘Solihull Primary Care Trust’ and posted to the address above.
NB. It has become necessary for the organizers to adopt the policy of charging £10 for non-attendance at Network education and training events in order to cover costs incurred and deter repeat offenders. Failure to pay may affect your eligibility to attend future Network Events. By registering for the day you are accepting these terms and conditions.
Please complete all sections
Surname:......
First Name: ......
Current Grade and Specialty ......
Current Hospital......
Newborn Network: (delete as appropriate)
SSBCNN / SWMNN / other (please specify) ......
Hospital Address: (external; candidates only)
Email address:
Preferred contact number:
Closing Date for Applications: Friday 21st September
Please assist us in ensuring that you are allocated to the workshops that best meet your needs.
The workshops will run concurrently, and you have the choice of 4 from the selection below.
Indicate using the grid below your preferred workshops in order of preference.We will do our best to ensure that you are allocated to the first 4 sessions of your choice. In the unlikely event that a workshop is oversubscribed throughout the day you may be asked to attend an alternative, as selected from your preference list. We will inform you of the sequencing of your individual workshop programme on the day.
Theme / Facilitators / *Preference[ 1 to 7 ]
Insertion and care of UAC / UVC / Mike James
Advanced Neonatal Nurse Practitioner,
Birmingham Women’s Hospital
HFOV - HFOV lung inflation/deflation/setup of HFOV / Dr.Alex Philpott
Consultant Neonatologist, WM Newborn Transport Service
Administration of Surfactant / Dr. Phil Simons
Consultant Neonatologist, Heartlands Hospital, Birmingham
Mrs. Jo Cookson
Network Practice Educator SSBCNN
Volume Control Ventilation, practical aspects / Dr.Jaideep Singh
Consultant Neonatologist, Heartlands Hospital Birmingham
Cardiac Assessment / Dr. David Roden
Associate Clinical Specialist
University Hospital of North Staffordshire
Blood pressure - how best to support the
circulatory system / Dr. Rob Negrine
Consultant Neonatologist
Birmingham Women’s Hospital
Transportation workshop / Mrs. Sonia Saxon
Advanced Neonatal Nurse Practitioner,
WM Newborn Transport Service.
*Indicate which workshops you would like to attend by numbering from 1 to 7. 1 = first choice; 7 = last choice