Registration Form

Definitive Surgical and Anaesthetic Trauma Care Course 2024

Ik meld me aan

Ik meld me af

up load your passport photo here *

I would like to register for course A on 5 & 6 November 2024 as: *

Anaesthesiologist/intensivist (DATC) - € 2575,00 (8/8)

[Unfortunately this course is full, please register for the other course or the waitlist]

OR-Nurse - € 750,00 (7/7)

[Unfortunately this course is full, please register for the other course or the waitlist]

Nurse Anaesthesist - € 750,00 (6/6)

[Unfortunately this course is full, please register for the other course or the waitlist]

Invited by Dutch Ministery of Defense, Anaesthesiologist/ intensivist (DATC) - € 0,- (2/3)

Invited by Dutch Ministery of Defense, OR Nurse - € 0,- (5/5)

[Unfortunately this course is full, please register for the other course or the waitlist]

Invited by Dutch Ministery of Defense, Nurse Anaesthetist - € 0,- (5/8)

No, I register for course B on 7 & 8 November 2024

I would like to register for course B on 7 & 8 November 2024 as: *

Anaesthesiologist/intensivist (DATC) - € 2575,00 (8/10)

OR-Nurse - € 750,00 (8/8)

[Unfortunately this course is full, please register for the other course or the waitlist]

Nurse Anaesthesist - € 750,00 (8/9)

Invited by Dutch Ministery of Defense, Anaesthesiologist/ intensivist (DATC) - € 0,- (4/4)

[Unfortunately this course is full, please register for the other course or the waitlist]

Invited by Dutch Ministery of Defense, OR Nurse - € 0,- (5/5)

[Unfortunately this course is full, please register for the other course or the waitlist]

Invited by Dutch Ministery of Defense, Nurse Anaesthetist - € 0,- (3/8)

No, I register for course A on 5 & 6 November 2024

If other, please fill here:

Position

Resident (AIOS)

Medical specialist

Other/ not applicable

Nurse

Start of anesthesiological training

-

-

Medical specialism *

Anaesthesiology

Intensive care

Other/ not applicable

Experience in trauma cases *

Less than 10 cases

Between 10-30 cases

More than 30 cases

Other/ not applicable

Dhr/Mw *

Titel

Voornaam *

Achternaam *

Land *

Postcode *

Huisnummer *

Straat *

Plaats *

Date of birth: *

-

-

E-mailadres *

Function

Organisation

Z-number (only for Radboudumc employees)

BIG (if not applicable then please fill in 0) *

Food Allergy or Dietary Wishes

Would you like to join the dinner on day 1 of the course (included in the price) *

Yes

No

I agree with the general terms and conditions *

(download voorwaarden)

Betalingsopties

Totaal: € 0,00