Emergency Surgery Course
Ljubljana, May 5th - 6th, 2023
DOMUS MEDICA
Dunajska cesta 162
1000 Ljubljana
Name
*
Miss
Mr.
Mrs.
Dr.
Prof
Prefix
First Name
Last Name
Email
*
example@example.com
Speciality
*
General Surgery
Emergency Surgery
Trauma Surgery
Vascular Surgery
Anesthesiology
Orthopedics
Affiliation
Name of your Facility
Country
*
Address of your Facility
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Scientific Societies Membership
ESTES member
AAST member
Leave blank if you are not member of ESTES or AAST
RESIDENT
*
YES
NO
Submit
Should be Empty: