Aortic 360 Basic Seminar 2023 Registration

Aortic 360 Basic Seminar
1) Personal Information
Title*
Name*

First Name Last Name
Date of Birth*

MonthDay Year
Date
Please upload your CV (curriculum vitae) in English*

Browse Files

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2) Affiliation – Working Place
Institution*
Address*

Street

Department/Division

City State / Province

Postal / Zip Code Country
Address for invoice (if different from above)

Street

Department/Division

City State / Province

Postal / Zip Code Country
E-mail*
Phone no.

Area Code Phone Number
Position*
Function
3) Professional experience
Please describe your current position and responsibilities*
4) Scientific or clinical interest
Please list fields of special scientific or clinical interest*
5) Expectations
Please let us know what you hope to accomplish by attending the Aortic 360 Basic Seminar*
6) Payment
Registration Fee (incl. VAT):*

Aortic Association member: CHF 300.-Aortic Association non-member: CHF 400.-
Aortic Association Membership number:*

Payment must be received by 15th February 2023.

Payment via wire transfer:

We look forward to welcoming you to the Aortic 360 Basic Seminar 2023.

Aortic 360 Basic Seminar