Application form

Dates and time:

23-25th September 2024
Start of course 08:00 23rd
End of course 15:00 25th

Location:
Karolinska University Hospital
Solna Stockholm, Sweden

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1. First name (Obligatoriskt)

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2. Last name (Obligatoriskt)

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3. E-mail: (Obligatoriskt)

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4. Mobile number (Obligatoriskt)

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5. Nationality (Obligatoriskt)

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6. Country of residence (Obligatoriskt)

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7. Institution / Hospital / Company / Organization (Obligatoriskt)

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8. Present profession and speciality / field of work

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9. Years in specialty/profession? (Obligatoriskt)

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10. I prefer to train in the following position (indicate by moving preferred choices to top): (Obligatoriskt)

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11. Attended previous national MRMI, (yes/no and year)

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12. Attended previous international MRMI course (yes/no, year) (Obligatoriskt)

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13. ESTES member (Obligatoriskt)

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14. Preferred method of payment

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

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