Registration form

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Registration form

This course is intended EXCLUSIVELY for participants from Africa.

Email ID *

First Name as it should appear on the course completion certificate *

Surname as it should appear in the course completion certificate
*

Name of your Hospital / Institution *

Country of residence *

Profession *

Radiation Oncologist

Medical Physicist

Radiation Therapy Technologist

Other

AORTIC Membership Number, if available

Please NOTE:

Form processing may take days.
The course starts on 1st May 2024 and remains open for 6 months.
You will receive login details via e-mail shortly before the course kick-off
This course is intended exclusively for participants from African countries.
We cannot accept participants from other countries to this course.

Please make sure that your answers are truthful and that the form contains no mistakes before submitting.

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