APELSO ADULT ECMO TRAINING COURSE 2019
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; It will be shown on your certificate
Your answer
Last Name *
e.g. Chan ; It will be shown on your certificate
Your answer
Work Position *
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 information will facilitate our curriculum design to meet your training needs).
Current or Future Utilized Pump System
Background Survey (The following information will facilitate our curriculum design to meet your training needs.)
Choose Our Course *
Full course 14-17 October 2019
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