Medical Electives Booking Form

Please complete this booking form to include your address, and return to us with your deposit payment. If you do not have your pick-up and drop-off information at this point in time please leave these fields empty.

Please tell us a little about what you are doing now, so we can provide the best possible program for you. Your Program Here Where possible please choose a start date as the first Monday of your chosen month.
Make sure you have 12-month multiple trip travel insurance for your placement.

PAYMENT PREFERENCE

Please confirm whether you wish to receive a deposit invoice or an invoice for the full elective program cost. We ask that payment for either option is made within 2 weeks.

RETURN TRAVEL

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