KSS Publication Request Form

Please fill out this form in order to request copies of a publication.

Title: *

Your title e.g. Dr, Miss, Mr

First Name: *

Your first name

Last Name: *

Your last name

Address: *

Your postal address

Email: *

Your email address, which you may be contacted on regarding this order enquiry

Trust: *

Your NHS Trust

Site: *

the site/hospital where you are based

Purchase Order Number: *

Your purchase order number for this order

Publication: *

GEAR 3rd edition (£12.50 excluding P&P)

Conversations from the field (£5.00 + P&P)

QESP Interim Evaluation

ROADS to Success - 3rd edition (£6.00 + P&P)

Journeys in Medical Education (£12.95 + P&P)

Please select a publication

Number of copies of publication: *

the number of copies of the publication requested. Please redo this form if you want multiple different publications

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