Course registration

Dual Energy

May 3-4, 2018, Germany

Please complete the form below and send your registration by ticking the send button on the bottom of the page. An automatically generated confirmation will then be sent to you which only indicates that we are in receipt of your registration. All incoming registrations will then be confirmed subject to availability.

Participant

First name *
Surname *
Email address *
Phone *
Cost center *
Your manager's name *
Hospital *
Clinic
Reference number *
Invoice Address *

Will you attend the dinner?

Yes No

Enter any food allergy

Profession

Doctor
Nurse
Physicists
Another

Message

Condition

I accept the conditions provided for in our General Conditions covering training *

General Conditions * All fields marked with an asterisk ( *) are required. Registration is binding.

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