Welcome to the Faculty of Sports and Exercise Medicine

Individual Registration

Please enter information in the form below to process registration for event FSEM Web 8 - The Young Athlete - 9th July 2022.

Salutation *

First Name *

Last Name *

Email *

Payment Options *

Fellows & Members €20.00

Non Fellows & Members €25.00

Your Location (Hospital or County)

Irish Medical Council Number (if applicable)

Profession: (GP, Consultant, Nurse, Allied Healthcare Professional, Other). *

Profession If Other:

Please tick the box option if you are happy for me to send on your details to Medcafe *

Amount

€

Payment Method

RCSI Credit Card Payments

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*