Registration Form

Definitive Surgical and Anaesthetic Trauma Care Course 2023

I would like to register

I would like to deregister

I would like to register for course A on 7 & 8 November 2023 as: *

Anaesthesiologist/intensivist (DATC) - € 2450,00 (12/12)

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

OR-Nurse - € 600,00 (4/4)

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

Nurse Anaesthesist - € 600,00 (4/8)

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

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

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

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

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

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

I would like to register for course B on 9 & 10 November 2023 as: *

Anaesthesiologist/intensivist (DATC) - € 2450,00 (10/10)

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

OR-Nurse - € 600,00 (4/7)

Nurse Anaesthesist - € 600,00 (11/11)

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

Invited by Dutch Ministery of Defense, Anaesthesiologist/ intensivist (DATC) - € 0,- (2/4)

Invited by Dutch Ministery of Defense, OR Nurse - € 0,- (7/8)

Invited by Dutch Ministery of Defense, Nurse Anaesthetist - € 0,- (2/8)

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

Mr./Ms. *

Title

First name *

Last name *

Country *

Postal code *

Street No. *

Street *

City *

Date of birth: *

-

-

Email address *

Function

Organisation

Z-number (only for Radboudumc employees)

GROOT(indien u geen BIG nr heeft gelieve nul in te vullen) *

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 terms)

Total: € 0.00