Houston Elective Rotation - Registration Form
This is the Registration Form for the Elective Rotation at the Heart & Vascular Institute at Memorial Hermann Hospital in Houston under the mentorship of Dr. Igor D. Gregoric.

Expect a response from MMSA in the next 72 hours to confirm your registration. During this period cancellations are still possible at houston@medicinec.si. After we confirm your registration it is final and no further changes are possible. Please be 100 % positive that you can attend the elective on the desired date before registering.

IMPORTANT: Make sure to consult the listing of vacant spots before submitting your registration. If you register for an occupied spot, your registration will be discarded without further notice. The listing is available at http://www.medicinec.si/houston/

Please make sure to also read all the materials available at http://www.medicinec.si/houston/ before submitting your registration.

Name *
Your full name
Your answer
E-mail Address *
Your answer
Phone Number *
Phone number with international dialing prefix and without spaces (e.g. 0038631726221)
Your answer
Medical School *
Elective program *
Mark the program that you wish to attend. You can also request to participate in both programs.
Required
Month of rotation *
Select the month when you wish to participate in the rotation. If you're applying for a double rotation, select the first month. In case there are no vacancies we will try to arrange for a different slot.
Comments
If you have any further questions or remarks feel free to ask and we'll address them in our response. Be sure to read all the publicly available materials on the web page beforehand.
Your answer
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