International MRMI Course, Karolinska, 2024

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

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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 train in the following position (indicate by moving preferred choices to top):

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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)

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* 13. ESTES member

Yes

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* 14. Preferred method of payment

Bank transfer

Invoice

International MRMI Course, Karolinska, 2024

Application form

Question Title

* 1. First name

Question Title

* 2. Last name

Question Title

* 3. E-mail:

Question Title

* 4. Mobile number

Question Title

* 5. Nationality

Question Title

* 6. Country of residence

Question Title

* 7. Institution / Hospital / Company / Organization

Question Title

* 8. Present profession and speciality / field of work

Question Title

* 9. Years in specialty/profession?

Question Title

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

Question Title

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

Question Title

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

Question Title

* 13. ESTES member

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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)