Registration //

 

 

FETAL NEUROSONOGRAPHY MASTERCLASS
June 2015
Registration Form

Surname: ...............................................................................................................................................
Name: .....................................................................................................................................................
Place of work: .......................................................................................................................................
Address: ................................................................................................................................................
Zip Code: .......................... City: .............................................. Country …………………………………
Phone: ..................................................................................... Fax: ....................................................
Cell phone: ................................................... E-mail: ........................................................................
Please fill carefully your name and e-mail address, they will allow to be known from the course managers and to assure the follow-up of your registration.
Number of Obstetric US performed / month:
Number of neurosonographic examinations performed/ month:
Did you have diagnosed complicated CNS anomalies? : YES NO
Experience in TVS Obstetrical examinations YES NO
Experience in 3D/4D of the brain YES NO
Registration will be strictly based on first registered first served rule. If there will be no available places for this course, application will received priority for the next one.
The registration will be definitive only after confirmation of the school 
Following the receipt of this registration form you will receive by e-mail instructions for payment.