Liverpool Course on Management of Chronic Pain: “A Practical Approach” 4th -6th July 2019 If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Title Dr Professor Mr Mrs Ms First Name Last Name * Address * Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of The Cook Islands Costa Rica Cote D'Ivoire Croatia (Local Name: Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Timor-Leste (East Timor) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy City (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic Of Korea, Republic Of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, Former Yugoslav Republic Of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia, South Sandwich Islands South Sudan Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic Of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe Zip / Post Code Job Title * Place of Work * Email * Phone Dietary Requirements * None Vegetarian Vegan Gluten Free Halal Nut Allergy Dairy Free Session Choices Thursday 4th July AM Clinic - 1st Choice * Acute Sciatica Spinal Pain & Neuromodulation CRPS Female Pelvic Pain PMP Assessment Clinic Opioid (Detox) Clinic Session Choices Thursday 4th July AM Clinic - 2nd Choice * Acute Sciatica Spinal Pain & Neuromodulation CRPS Female Pelvic Pain PMP Assessment Clinic Opioid (Detox) Clinic Session Choices Friday 5th July AM Workshop 1st Choice * Live Pain Neuromodulation Theatre session Ultra Sound (USG) Guided procedures Capsaicin patch application and Botox for chronic pain Refractory angina management: Practical Live Pain Spinal Procedures Theatre session Session Choices Friday 5th July AM Workshop 2nd Choice * Live Pain Theatre session Ultra Sound (USG) Guided procedures Capsaicin patch application and Botox for chronic pain Refractory angina management: Practical Live Pain Spinal Procedures Theatre session Session Choices Friday 5th July PM Workshop 1st Choice * Live Pain Neuromodulation Theatre session Ultra Sound (USG) Guided procedures Live Pain Spinal Procedures Theatre session Capsaicin patch application and Botox for chronic pain Refractory angina management: Practical Session Choices Friday 5th July PM Workshop 2nd Choice * Live Pain Neuromodulation Theatre session Ultra Sound (USG) demonstration & hands on workshop Live Pain Spinal Procedures Theatre session Capsaicin patch application and Botox for chronic pain Refractory angina management: Practical Star Rating
