Application Form - PSUOG - Permanent School of Ultrasound in Obstetrics and Gynecology

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Permanent School of Ultrasound in PSUOG Obstetrics and Gynecology

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On-site training/diplomas
On-line Lectures
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On-line Consulting
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News/Newsletter
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Contacts – Where We Are

PSUOG Courses/Diplomas Application Form

Personal data
Name*
First Name Last Name(s)
Date of Birth*
MM
DD
YYYY
Place of birth*
Nationality*
Postal Address*
E-mail Address*
Phone Number*
Current employment jobs/employment*
Job Address*
Education
Degree
Diploma(s)
Internships
Practical Year
Research Projects
Publications (choose the main 5)
Application for:
Course/Diploma (choose one from the list):*
Date
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DD
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Signature

© Permanent School of Ultrasound in Obstetrics and Gynecology – PSUOG – All rights reserved

Permanent School of Ultrasound in Ob/Gyn (PSUOG) c/o European Medical and Research Center

via Del Giochetto 53/A, 06122, Perugia (Italy)
Director: Graziano CLERICI, MD PhD
email: info@psuog.net

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