Workshop Registration - joimax international

Please understand that we have preliminary criteria which have to be accomplished for participants. For every course a specific agenda will be prepared providing all details related to the selected date, e.g. location, time schedule, hotel options, faculties. In general, international courses are held in English.

WORKSHOP CATEGORY*

Date *

PACKAGE* (only available for 2-day courses in U.S.)

2-Day Course

The course fee includes course materials and joimax^® scrubs.

2-Day Course and personal X-ray protection package

The course fee includes course materials, joimax^® scrubs and the personal X-ray-protection package consisting of a custom joimax^® gown (monogrammed optional), thyroid shield, X-ray glasses. Ordering details as sizing and monogramming will be taken care of at the workshop.

PARTICIPANT*

Ms.Mr.

FIRST NAME, LAST NAME, MEDICAL DESIGNATION (MD, PhD, DO, etc.)*

SPECIALIZATION*

DEPARTMENT / FUNCTION

INSTITUTION / PRIVATE PRACTICE*

STREET ADDRESS OF INSTITUTION / PRIVATE PRACTICE*

CITY, STATE, ZIP CODE OF INSTITUTION / PRIVATE PRACTICE*

COUNTRY*

PLEASE, LEAVE YOUR EMAIL OR PHONE NUMBER*

PLEASE BILL TO:

ParticipantInstitute

I accept the privacy policy*

Data privacy statement

General statement:
We take the protection of your personal information very seriously and strictly adhere to the rules of data protection laws. Personal data is collected on this website only to the extent technically necessary. In no case will the data collected be sold or otherwise disclosed to third parties.

* Required fields