APELSO ADULT ECMO TRAINING COURSE 2017
Jointly organized by ELSO, Asia-Pacific ELSO, HKAM, Queen Mary Hospital & Grantham Hospital (Hong Kong)
Registration Form
Title
First Name
e.g. Perry Tai Man (English name first)
Your answer
Last Name
e.g. Chan
Your answer
Department
Your answer
Institution
Your answer
Address
City; State; Country; Zip; (For sending certificate and receipt if necessary)
Your answer
Telephone
Your answer
Fax
Your answer
Email Address
We will update the program information to you by email.
Your answer
Career
Background Survey (The following information will facilitate our curriculum design to meet your training needs).
Year of Experience in ECMO
Background Survey (The following infomration will facilitate our curriculum design to meet your training needs).
Current or Future Utilized Pump System
Background Survey (The following infomration will facilitate our curriculum design to meet your training needs.)
Choose Our Course
Payment
(Credit card payment or Paypal not available.)
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