Academyium Courses

What short name you prefer to be called on he day of the course? *

You work in: (Trust and Hospital) *

Your grade is a/an: *

Consultant ACCS or HST trainee ACP or ACP trainee MG/SAS Junior doctor Other

ACCS or HST trainee? level:

CT1 CT2 ST3 ST4 ST5 ST6 Other

ACP? level:

ACP trainee Qualified ACP Other

MG/SAS? level:

CESR MG/SAS Non-CESR MG/SAS Locum based MG/SHO Other

Junior Doctor? level:

FY1 FY2 F3 SHO Locum SHO Other

Your speciality *

Emergency Medicine qualified (or Trainee) Non-Emergency Medicine (locuming in ED) Other

(1) I CONFIRM to adhere to all IPC regulations. All stations will provide gloves and hand sanitiser. (2) I CONFIRM that I will not attend on the course day if I got any COVID symptoms or been tested positive in a formal or lateral flow test. I will not attend if I am asked to self-isolate or any of my household are having COVID symptoms. And I will notify the course organisers. (3) I CONFIRM that I give consent to the course organisers to check my temperature and to record it on the day of the c *

I confirm to adhere to the above

(1) Please be advised that we might use meat and animal product as modules for the purpose of procedure training. (2) Please notify the course organizers if you have any allergies or pre-exist medical conditions in which exposure to meat is not recommended. *

Yes I confirm

Have you completed the RCEM (or any other equivalent) POCUS online module. Link was sent separately. *

Yes No

Have you got the link for the log book forms for cases sign-off? *

Yes No

Have you attended any US/POCUS courses before *

Yes No

How often you use US/POCUS in your clinical work *

Many times on daily basis At least once per day Once or twice per week Not very often Never used it

What do you usually use POCUS for? *

I need this course for *

US core level Sign off To further my knowledge in relation to POCUS Other

Dietary Requirements (Select all that apply)

None Halal Vegetarian Vegan Gluten-Free Dairy-Free Nut Allergy Other

Academyium Refund Policy -- Please confirm that you have read our Refund policy carefully before completing your registration. Link: https://academyium.com/about#refund-policy *

I Confirm

Regional US Day - East Midlands

Personal Details

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