Welcome to the MIMS Oncology & Palliative care registration page

Please answer all questions as fully as possible, then click the 'register' button on the bottom of the form

Note: The fields marked X must be completed

Title : X
First name: X
Last name: X
Job Title : X
Organisation Name : X
Address : X
Postcode: X
Country : X
Business Tel : X
Business Fax :
Business Email : X

1) Do you have a special interest in oncology and palliative care?

tick one only X
Yes
No

2) Your job function

tick one only X
GP - Enter GMC No.
Consultant - Enter GMC No.
Nurse - Enter NMC No.
Other

3) Where are you based?

tick one only X
A hospital
The community
Private clinic
Other

4) Your interest in oncology and palliative care

tick all that apply X
I am a specialist in oncology and palliative care
I am involved in training others in oncology and palliative care
I am the lead practioner at my place of work in oncology and palliative care
I am involved in the running of a clinic in oncology and palliative care
None of the above

5) Would you be interested in writing for us?

X

RECOMMEND A COLLEAGUE

Recommend a colleague to receive free copies

Name
Job Title
E-Mail Address

Normally you are asked to sign a registration card to validate your free subscription, but this is not possible on a web page. Instead we ask a qualifying question that must be answered:
What is your shoe size? X

By registering for this free publication Haymarket Medical Media will automatically provide you with information relating to your subscription and other Haymarket-related products and services via either email, direct mail or phone. Please note that our email and direct mail products may contain promotional materials from pharmaceutical companies or other third party sponsors.
Haymarket Medical Media reserve the right to limit the number of copies sent to one company or address and to refuse an application for a free copy if the applicant does not comply with the terms and conditions of receipt.

Please Note:Haymarket Medical Publications Ltd reserves the right to limit the number of free subscriptions available to individuals meeting the terms of control.