PRINT NAME AS TO APPEAR ON CERTIFICATE…………………………………………………………….......

First name: .................................................................. Surname: ..............................................………………

Address for correspondence:

............................................................................................................................................................................

............................................................................................................................................................................

Mobile No: .................................................... Email Address: …………………………………………………...

Specialty: .............................…………..Hospital: …………………………………Grade………………………..

Are you on an RCSI Surgical Training Programme Yes / No

(CST or CSTEM) (HST – ASTEM) (Please circle)

Irish Medical Council (or GMC) Number................................................(*Mandatory Requirement)

Preferred Course Venue (Please number in order of preference):

2019 RCSI Dates 2019 Regional Centres
RCSI 12th / 13th February 2019 Instructor Course
(Separate Application Form)

RCSI 6th- 8th March 2019 Cork 10th – 12th April 2019
RCSI *22nd – 24th May 2019 Sligo 22 – 24th May 2019
*(this date is subject to change) Kilkenny 22 – 24th May 2019
RCSI 16th – 18th October 2019 Drogheda 4th – 6th September 2019
RCSI 20th – 22nd November 2019 Sligo 28th / 29th November 2019
Limerick 13th – 15th November 2019
Beaumont 28th/29th November 2019

If no venue preference, tick here □

Fee: €875.00 Payment is not required until you have been allocated a course date.
Cheques or Bank Drafts should be made payable to "Royal College of Surgeons in Ireland". We
accept Visa / Visa Debit / Mastercard.
Please note while it is our intention to meet all mandatory training requirements, funding will be
subject to review and approval by the HSE/ NDTP on an annual basis. Please see overleaf for
more information.
Cancellation: A refund, less 20%, will be made if written notice of withdrawal is received by the College at
least one month prior to the course commencement. No refund will be made after this date. Completed
application form, together with two passport-sized photographs, should be returned to: ATLS National
Coordinator, Surgical Affairs, The Royal College of Surgeons in Ireland, 121 St Stephen's Green, Dublin 2.

Please Submit Please Submit

Tel: 353 1 402 8642  Fax: 353 1 402 2459 nationalatlscoordinator@rcsi.ie 2019
Cont/d…2
MANDATORY FUND
Specialty Trainees
SPECIALIST TRAINING FUND
Specialty Trainees
CLINICAL COURSES AND
EXAMS FUND
All Trainees / NCHDS
ATLS Refund Scheme
Emergency Medicine
Trainees
Tel: 353 1 402 8642  Fax: 353 1 402 2459 nationalatlscoordinator@rcsi.ie
 Run by RCSI on behalf of HSE/NDTP.
 For approved mandatory courses only.
 EUR 1200 maximum per year per trainee.
 Funding is not carried over year-on-year.
 Trainees must have approval for the course before claiming.
 Run by RCSI on behalf of HSE/NDTP.
 For training courses/activities, equip, books, expenses.
 EUR 500 per year per Trainee.
 Funding is carried over year-on-year e.g. 3 years unclaimed will give the Trainee €1500 to claim.
 Run by HSE/NDTP for courses and exams only on the approved list.
 EUR 450 per claim, no restrictions on how many claims can be submitted per year.
 Trainees must claim for this fund through the HR Departments in their hospital within 6 months
of attending the exam/course.
 Guidance document accessible via this link:
http://www.rcsi.ie/files/surgery/20160115095430_CCE%20refun%20doc2016%20(2)%2015%20Ja
n.p.pdf
Please contact the Emergency Medicine Administrator
Lisette Biggins RCSI @402 2113
Open To EM Core Trainees only.
2019