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Application form

Dates and time:

22-25 September 2024
Start of course 13:00 22th
End of course 15:00 25nd

Location:
Karolinska University Hospital
Solna Stockholm, Sweden

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* 1. First name

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* 2. Last name

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* 3. E-mail:

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* 4. Mobile number

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* 5. Nationality

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* 6. Country of residence

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* 7. Institution / Hospital / Company / Organization

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* 8. Present profession and speciality / field of work

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* 9. Years in specialty/profession

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* 10. I prefer to instruct the following position (indicate by moving by grading your choices):

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* 11. Previous MRMI course year and location 

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* 12. ESTES member

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* 13. Preferred method of payment

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* 14. Billing adress for invoice (can be provided also by e-mail later)

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