Global Kidney Academy
We educate – We hold hands
Global Kidney Academy
Haemodialysis Online Course (HOC)
Application Form
Please return form to [email protected]
Course name
Haemodialysis Online Course (HOC)
Your details
First name
Last name
Date of birth
Gender
Male
Female
Country of origin
Country of practice
Organisation / Home contact details
Position/Job title
Specialty
Professional qualifications
Home address
Telephone number
Email address (as used on
Online Academy [OLA])
OLA username
How did you hear about this Course?
Please provide us with a brief biography that describes your career to date and briefly
http://www.globalkidneyacademy.co.uk, [email protected]
Tel/Fax - 00 44 (0) 114 2361604
1 Ryecroft Court, Ryecroft Glen Road, Sheffield, S17 3NG, UK
Company Number 07158635
VAT Registration Number 153461325
Global Kidney Academy
We educate – We hold hands
describe your reasons for applying for this Course.
Terms and Conditions
These terms and conditions apply to all participants on a GKA NOC.
The Global Kidney Academy (GKA) Haemodialysis Online Course (HOC) provide a range of
modules that are entirely delivered online and consist of a range of educational resources
including lectures, case discussions, reading material, assignments, self-assessment exercises
as well as final evaluation involving of a range of options: MCQs, mini essays as well as work
based assignments.
The Course is delivered exclusively in English so it is important that you have a good
understanding and written and spoken English.
The GKA HOC is delivered by a Faculty of international authorities in the field led by Professor
Meguid El Nahas, PhD, FRCP, Professor of Nephrology and Chairman of the GKA and
Professor Arif Khwaja, PhD, FRCP, Consultant Renal Physician at the Sheffield Kidney Institute
and Online Academy (OLA) Director.
Successful completion of the Course entitles the applicant to a Certificate endorsed by the
Global Kidney Academy and delivered electronically to the successful candidate on completion
of the Course.
The GKA, a UK registered company, is an independent educational organisation committed to
the promotion of Education & Leadership in Nephrology worldwide.
(http://www.globalkidneyacademy.co.uk/index.php).
http://www.globalkidneyacademy.co.uk, [email protected]
Tel/Fax - 00 44 (0) 114 2361604
1 Ryecroft Court, Ryecroft Glen Road, Sheffield, S17 3NG, UK
Company Number 07158635
VAT Registration Number 153461325
Global Kidney Academy
We educate – We hold hands
Declaration
In order to access the course, I confirm that I am registered on OLA and will use the email
address registered to my username.
I accept the Terms and Conditions and accept to pay the registration fee will of $500.00.
The fee is not reimbursable except if for some unforeseen reason the Course is not run as
planned by the GKA.
Successful completion of the Course and passing the statutory evaluation set by the Course
Faculty, led by Professor Meguid El Nahas, PhD, FRCP, Professor of Nephrology and
Chairman of the Global Kidney Academy will entitle me to a Certificate from the Global Kidney
Academy.
Financial information
Please tick here to confirm your willingness to pay the full fee for this Course
The following information is necessary for you to make the transfer to the Global Kidney
Academy. In order to trace your payment, please make sure that your name appears as
the payer.
Account name
Global Kidney Academy Ltd
Bank name
Santander UK PLC
Bank address
IBAN
Santander UK PLC
Bridle Road
Bootle
L30 4GB
UK
GB 04 ABBY 090127 78882988
SWIFT
ABBYGB2LXXX
Please ensure that your name appears on the transfer.
http://www.globalkidneyacademy.co.uk, [email protected]
Tel/Fax - 00 44 (0) 114 2361604
1 Ryecroft Court, Ryecroft Glen Road, Sheffield, S17 3NG, UK
Company Number 07158635
VAT Registration Number 153461325
Global Kidney Academy
We educate – We hold hands
Completing your application
I confirm that in signing this application I have read and understood the terms and conditions,
and that I have the authority to agree them.
I understand that I have a commitment to complete the HOC Course and that failure to do so
may result in me not being awarded a Certificate from the Global Kidney Academy
I have read and agree with the Course Terms and Conditions
Applicant signature
Date
For use by GKA Administration
Registration Form received
Registration Fee received
Registration Number
http://www.globalkidneyacademy.co.uk, [email protected]
Tel/Fax - 00 44 (0) 114 2361604
1 Ryecroft Court, Ryecroft Glen Road, Sheffield, S17 3NG, UK
Company Number 07158635
VAT Registration Number 153461325