Submit TesT ALS application Please use this form to submit your application and make payment. We will be in touch, shortly. ALS Application (1) This field is hidden when viewing the formDate MM slash DD slash YYYY Already have an account? Please LoginTotal Course Dates(Required)Choose Required Course Date12 – 13 October 202426 – 27 October 202416 – 17 November 202414 – 15 December04 – 05 January 202511 – 12 January 202518 – 19 January 202525 – 26 January 2025AccommodationNo. of nights1 Night2 Nights3 Nights4 Nights5 Nights(£125 per night, subject to availability)AccommodationPersonal DetailsName(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Middle Last Badge Name(Required) Name you want on the ID Badge Address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mobile(Required)Work PhoneExtBleepEmail(Required) Create a username and passwordUsername(Required)Password(Required) Enter Password Confirm Password Strength indicator Special Physical Needs(Required)[Type No, if you have no special needs]Special Dietary Needs(Required)[i.e. Gluten free, Any allergy, Halal, No Beef, No Pork etc. Type No, if you have no special dietary needs]Professional Details[Please choose Not Applicable for any section that is not appropriate for you]Job Title(Required)Not ApplicableAssociate SpecialistClinical Fellow (Consultant Level)Clinical Fellow (Registrar Level)Clinical Fellow (SHO Level)ConsultantCore Surgical Trainee Year 2 (CST2)Core Surgical Trainee Year 1 (CST1)Core Trainee Year 2 (CT2)Foundation Year 2 (FY2)Foundation Year 1 (FY1)House OfficerPre-Registration House OfficerRegistrarResident Medical OfficerSenior House OfficerSpecialist RegistrarSpecialty DoctorSpecialty Trainee Year 8 (ST8)Specialty Trainee Year 7 (ST7)Specialty Trainee Year 6 (ST6)Specialty Trainee Year 5 (ST5)Specialty Trainee Year 4 (ST4)Specialty Trainee Year 3 (ST3)Specialty Trainee Year 2 (ST2)Specialty Trainee Year 1 (ST1)Staff GradeOtherSpeciality(Required)Not ApplicableAnaestheticsEmergency Medicine (Adult)Emergency Medicine (Paediatric)General PracticeIntensive Care (Adult)Intensive Care (Paediatric)Neonatal MedicineNeonatal SurgeryPaediatric MedicinePaediatric SurgerySurgery (ENT)Surgery (General)Surgery (Orthopaedics)Surgery (Plastics)Surgery (Trauma)OtherProfessional Registration Number (e.g. GMC, IMC, NMC, HCPC)(Required)(UK applicants only) – [Type N/A if you don’t have any of these number]Are You An International Medical Graduate Working/Living Outwith The UK?(Required) Yes No Which NHS Health Board or NHS Trust do you work in?(Required) NHS Ayrshire & Arran NHS Borders NHS Dumfries & Galloway NHS Western Isles NHS Fife NHS Forth Valley NHS Grampian NHS Greater Glasgow & Clyde NHS Highland NHS Lanarkshire NHS Lothian NHS Orkney NHS Shetland NHS Tayside Other N/A (UK applicants only) – [Select N/A if you don’t work for a NHS Health Board or Trust]Name of Hospital or Institution(Required)Address of Hospital or Institution(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please upload a recent photo of yourself(Required)Max. file size: 10 MB.If you do well at the course, would you like to be considered for instructorship?(Required)YesNoAccommodation RequirementsCheck In Day Month Year Check Out Day Month Year Do You Require BreakfastYesNoConsentBy continuing with the application, you understand that should retesting be needed for any element of the course, you have 3 months from the course date to complete it, and no extension to the deadline will be awarded.CommentsThis field is for validation purposes and should be left unchanged.
