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1. Please enter your full name in this format - Lastname Firstname *
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2. Please provide your GMC number *
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3. Are you a resident doctor or a doctor in a non-training post? *
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4. Please indicate your ST (stage of training) year if you are a resident doctor, or your status if you are a doctor in a non-training post. *
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5. Have you sat the Refraction Certificate before? (NOTE: the Pilot is only for those who have never sat the Refraction Certificate) *
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6. Do you intend to sit the Refraction Certificate in May 2026? (NOTE: the Pilot is only available for those who intend to sit the May 2025 exam) *
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7. Please indicate the name of your deanery *
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8. Please supply your email address *
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9. Are you happy for your contact details to be shared for the purposes of the Pilot? *