CEEA New Course Submission

CEEA New Course Submission

To be completed by Course Director on behalf of CEEA Centre Director
CEEA's Center*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Director's Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Next Course
How many courses have you planned*
The First Course*

1. Thorax and Respiration2. Heart and Circulation3. Intensive Care, Emergency Medicine, Blood and Blood Transfusion4. Mother and Child. Adverse Reactions5. Neurology, Regional Anaesthesia and Pain Management6. Specific Domains of Perioperative Medicine
Start Date of the course*

DayMonthYear
End date of the course*

DayMonthYear
The Second Course*

1. Thorax and Respiration2. Heart and Circulation3. Intensive Care, Emergency Medicine, Blood and Blood Transfusion4. Mother and Child. Adverse Reactions5. Neurology, Regional Anaesthesia and Pain Management6. Specific Domains of Perioperative Medicine
Start Date of the course*

DayMonthYear
End date of the course*

DayMonthYear
The Third Course*

1. Thorax and Respiration2. Heart and Circulation3. Intensive Care, Emergency Medicine, Blood and Blood Transfusion4. Mother and Child. Adverse Reactions5. Neurology, Regional Anaesthesia and Pain Management6. Specific Domains of Perioperative Medicine
Start Date of the course*

DayMonthYear
End date of the course*

DayMonthYear
Should be Empty:

Next Course