EuroSafe Imaging Stars Application Form
Organisation/Institution/Facility
Organisation Name *
Please enter your organisation/institution/facility's name as you would like it to appear in the official EuroSafe Imaging Stars list. In most cases, this will be e.g. 'Department of Radiology, XY Hospital/University'.
Your answer
Street *
Your answer
Postcode *
Your answer
City *
Your answer
Country *
Your answer
Homepage *
Your answer
Head of Imaging Department
Please enter the details of the person responsible for the organisation/institution/facility. To be eligible as a EuroSafe Imaging Star, this person must be an ESR member in good standing (see details on the ESR membership here: https://www.myesr.org/about/membership).
Title *
First Name *
Your answer
Last Name *
Your answer
Position/Job Title *
Your answer
Email Address *
Your answer
Person in charge of radiation protection / Main contact for EuroSafe Imaging (optional)
If different from head of imaging department
Title
First Name
Your answer
Last Name
Your answer
Position/Job Title
Your answer
Email Address
Your answer
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