Registration form to CEURF
Full name : .................................................................................
Discipline (intensivist etc): ..........................................................
Grade (Fellow etc): ....................................................................
Address where you want to receive your postal mail: ...............................................................................
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Tel.: ......................................................................
E-mail: ..................................................................
I want to register to the session of critical ultrasound, didactic day of : .............................
Participation* (includes didactic day, didactic support and lunch, one half-day of personnalized training):
320 Euros (one bedside stage), 475 Euros (two bedside stages), 640 Euros (three bedside stages).
Check to «CEURF», to be sent (with this paper) to:
CEURF - Service de Réanimation - Hôpital Ambroise-Paré
9 rue Charles de Gaulle - F-92100 Boulogne
Do not send any payement before registration is confirmed by the bureau.
Date: .............................
Signature:
This training can be endorsed by the permanent medical training.