Академический Документы
Профессиональный Документы
Культура Документы
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Month
Year
College ID:
Surname
First name
Day
Month
Year
Date of Birth
Gender
Nationality
Email
Correspondence Address
Mobile or Telephone
Registration Number
3.
5.
2.
4.
6.
From (date)
To (date)
Hospital
COLLEGE ID
OR
credit card
(Payable to CAI)
VISA
EXPIRY
VISA DEBIT
-
MM/YY
Security code
Amount 600
Name on card (block letters)
Cardholders signature
Send the completed form together with the full amount of the fee to:
College of Anaesthetists of Ireland
Examinations Department
22 Merrion Square North
Dublin 2
Ireland
Email: exams@coa.ie