Registration form for external CICM trainees’ hot case practice

Personal details

First Name

Last Name

Mobile number

Country of residence

Have you have had at least 3 COVID vaccinations? YesNo

Date of last influenza vaccination

Hospital name

Hospital country

Current position

Current Unit

Enter the name of the Unit/ department where you are currently working.

Enter your start date

The earliest date from which you will be available to attend hot case practice.

Upload a completed letter of acceptance

Download the template for the completed letter of acceptance. Only PDF and Word files allowed. Maximum file size is 2MB.

Upload proof of medical registration (APHRA)

Only PDF and Word files allowed. Maximum file size is 2MB.

Upload proof of identity

Photographic identification e.g. passport page. Only PDF and Word files allowed. Maximum file size is 2MB.

Upload proof of COVID-19 vaccination

Only PDF and Word files allowed. Maximum file size is 2MB.