Post Mortem in Practice - an Intensive Course on the Practice of Post Mortem Diagnostics Intensivkurs Autopsie mit Schwerpunkt auf die Praxis der obduzierenden Diagnostik
Submit application ( Please fill in application form carefully, all data are required, except optional )
Please note, that all transaction fees are payable by the payer. Teaching fee is 2 500.- €/2 weeks.
In case tuition fees are paid via
- bank transfer: please indicate name of participant in the Communication (note to payee) field,
- credit card: please indicate beneficiary cardholder 's name so that payment can be allocated to the attendee
I would like to pay via bank transfer:
(select "Yes" or "No" from menu)
or
Cardholder 's name: (leave blank "Cardholder 's name" ,when you selected "Yes" for paying via bank transfer)
Personal data of applicant
Name of applicant: Title:
First Name:
Surname:
Date and place of birth: Day:
Month:
Year:
Sex:
Place of birth:
Home country and city: Country:
City:
Nationality:
Availabilities: ( for phone and fax number use only numbers, spaces, hyphens - e.g. 12 34 456-7890, 123-45-678-9101, 12 345 6789, 123 456-7890, etc.
- add a working e-mail address due to the confirmation e-mail automatically sent to you after your registration )
Phone:
Fax:
e-mail:
Professional data of applicant
Affiliation ( delegating institution ): Name:
Address:
Phone:
Professional History: Year of medical diploma:
Years in pathology:
Name and year of speciality diplomas - if applicable (optional): Name:
Year:
Date of expected speciality exam in pathology - if applicable (optional): Month:
Year:
Course data
Desired date of the course (dates are in DD.MM.YYYY format - primarily date required, others are optional):
Primarily:
Secondarily:
Thirdly:
Teaching language desired: Language:
Accomodation offer needed: Accomodation:
