Registration Form

Definitive Surgical and Anaesthetic Trauma Care Course 2024

I would like to register for course A on 5 & 6 November 2024 as:

Surgeon (DSTC) (16/17)

Orthopaedic Surgeon (15/15)

[Unfortunately this course is full, please register for the other course or the waitlist]

Invited by Dutch Ministery of Defense (4/7)

I would like to register for course B on 7 & 8 November 2024 as:

Surgeon (DSTC) (14/17)

Orthopaedic Surgeon (7/14)

Invited by Dutch Ministery of Defense (10/10)

[Unfortunately this course is full, please register for the other course or the waitlist]

Position

Resident

Medical specialist

Other/ not applicable

Start of Surgical Training

Medical specialism *

Traumatology/surgery

Orthopedics

Other/ not applicable

Experience in trauma cases *

Less than 10 cases

Between 10-30 cases

More than 30 cases

Other/ not applicable

Dhr/Mw *

Titel

Voornaam *

Achternaam *

Land *

Postcode *

Huisnummer *

Straat *

Plaats *

Date of birth: *

E-mailadres *

Up load your Passport Photo here *

Organisation

Z-number (only for Radboudumc employees)

BIG nr. (in case you do not have a BIG nr please fill in zero) *

Food Allergy or Dietary Wishes

Would you like to join the dinner on day 1 of the course (included in the price)

Yes

I agree with the general terms and conditions *

(download voorwaarden)

Surgeon (DSTC)

€ 2.575,00

Orthopaedic Surgeon

€ 2.575,00

Totaal: € 0,00

Registration Form

Betalingsopties

DSATC surgeons registration 2024