GEST MSK 2025 – Request for a grant support GEST MSK 2025 – Request for a grant support https://form.comnco.net/wp-content/themes/movedo/images/empty/thumbnail.jpg 150 150 Com&Co Form Com&Co Form 2 juillet 2024 2 juillet 2024 GEST MSK 2025 - Request for a grant support Family name*First name*E-mail adress*Cell phone number*Cell phone number (only) Please indicate in front of your phone number, the country dialling code of your country.Affiliated Medical Center*Country*City*REGISTRATIONI register as :* Physician Fellow Intern Paramedics N° RPPS (only for french physician/paramedic)*If you do not have an RPPS number, please note in this section "N/A". Did you attend the GEST MSK 2024 meeting in Paris?* Yes Non Do you currently perform MSK embolization?* Yes Non Please indicate what procedures and how many you have done until now : GEA* Less than 5 cases 5-9 cases More than 10 cases Frozen Shoulder* Less than 5 cases 5-9 cases More than 10 cases Epicondylitis* Less than 5 cases 5-9 cases More than 10 cases Other (please specify procedure name and number of cases)Based on what you know, which of the following companies have products or will be introducing products for embolotherapy in MSK in the next year?* Guerbet Merit Medical Terumo Boston Scientific Cook Medical Varian Other (please specify) Other (please specify)*What embolic material(s) have you been using?* Embosphere Embozene Lipiodol emulsion Imipenem-cilastatin Other Other (please specify)*What embolic material(s) would you like to use in the coming year?* Embosphere Embozene Lipiodol emulsion Imipenem-cilastatin Other Other (please specify)*What is your preferred microcatheter?*What is the main limitation for you to start/grow your practice?* Not confident enough Not enough evidence No referral by rheumatologist/orthopedic No access to an embolic in which I am confident Not convinced that this will work In what ways can we help you in overcoming the limitation you mentioned?*How knowledgeable would you say you are about performing MSK procedures?* I'm a newbie More to learn I'm an expert How would you like to learn more about MSK procedures? Check all that apply.* An MSK Online Community In-depth, interactive webinars on MSK MSK focused In-person meeting Visit an expert center and attend cases A certificate program to build your practice Do you have access to Imipenem Cilastatin?* Yes No How long have you been a practicing physician?* Under 5 years 6-10 years 11-15 years 16-20 years >20 years In what country do you practice?*AfghanistanAfrique du SudAlbanieAlgérieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArménieArubaAustralieAutricheAzerbaïdjanBahamasBahreïnBangladeshBelarusBelgiqueBelizeBermudesBhoutanBolivieBonaire, Saint-Eustache et SabaBosnie-HerzégovineBotswanaBrunei DarussalamBrésilBulgarieBurkina FasoBurundiBéninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCorée (République de)Corée (République populaire démocratique de)Costa RicaCroatieCubaCuraçaoCôte d’IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatiniFidjiFinlandeFranceFédération RusseGabonGambieGhanaGibraltarGrenadeGroenlandGrèceGuadeloupeGuamGuatemalaGuernseyGuinéeGuinée équatorialeGuinée-BissauGuyaneGuyaneGéorgieGéorgie du Sud et Îles Sandwich du SudHaïtiHondurasHong KongHongrieIndeIndonésieIrakIranIrlandeIslandeIsraëlItalieJamaïqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKoweïtLa BarbadeLa RéunionLesothoLettonieLibanLiberiaLibyeLiechtensteinLituanieLuxembourgMacaoMacédoine du NordMadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicronésieMoldavieMonacoMongolieMontserratMonténégroMozambiqueMyanmarNamibieNauruNicaraguaNigerNigériaNiuéNorvègeNouvelle-CalédonieNouvelle-ZélandeNépalOmanOugandaOuzbékistanPakistanPalauPanamaPapouasie-Nouvelle-GuinéeParaguayPays-BasPhilippinesPolognePolynésie françaisePorto RicoPortugalPérouQatarRoumanieRoyaume-UniRwandaRépublique DominicaineRépublique TchèqueRépublique arabe syrienneRépublique centrafricaineRépublique démocratique du CongoRépublique démocratique populaire du LaosSahara occidentalSaint BarthélemySaint MartinSaint Pierre et MiquelonSaint-Christophe-et-NevisSaint-MarinSaint-SiègeSaint-Vincent-et-les GrenadinesSainte-Hélène, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa américainesSao Tomé et PrincipeSerbieSeychellesSierra LeoneSingapourSint MaartenSlovaquieSlovénieSomalieSoudanSoudan du SudSri LankaSuisseSurinameSuèdeSénégalTadjikistanTanzanie (République-Unie de)TaïwanTchadTerres Australes FrançaisesTerritoire britannique de l’océan IndienThaïlandeTimor orientalTogoTokelauTongaTrinité et TobagoTunisieTurkménistanTurquieTuvaluUkraineUruguayVanuatuVenezuelaVietnamWallis et FutunaYémenZambieZimbabweÉgypteÉmirats arabes unisÉquateurÉrythréeÉtat palestinienÉtats-UnisÉthiopieÎle BouvetÎle ChristmasÎle MauriceÎle NorfolkÎle de ManÎles CaymanÎles CocosÎles CookÎles FalklandÎles FéroéÎles Heard et McDonaldÎles Mariannes du NordÎles MarshallÎles PitcairnÎles SalomonÎles Turques et CaïquesÎles Vierges américainesÎles Vierges britanniquesÎles de Svalbard et Jan MayenÎles mineures américainesÎles ÅlandWhat is your area of specialty* Interventional Radiology What is your practice setting?* Academic Private Practice VA/Government For profit hospital/health system Not for profit hospital/health system ACCOMMODATION Select the number of night(s) you would like to stay* Night from January 17th to 18th Night from January 18th to 19th I do not need an accommodation This package includes a single room for two nights at the hotel. All the information concerning your hotel will passed on to you before the event. Special accommodation requestsTRANSPORTAirport and/or station tranfers will be handled by the organization. You will receive detailed information in your travel book few days before your departure by email. Your flight will be in economic class, if you wish to travel in business class, it will be to your own charge.Do you need a transportation booking?* Yes No Departure city*Departure date*Departure time* Morning Afternoon Evening Return city (if it is not departure city)Return date*Return time* Morning Afternoon Evening Membership card type and number (airline, railroad company...)Preferred Airline companyUpload your passport or ID Card*Types de fichiers acceptés : jpeg, jpg, png, pdf, gif, Taille max. des fichiers : 128 MB.Essential to book your travel. Thanks.Special travel requests (aisle, window...)We will reimburse you up to : - France : 450€ - Out of France : 750€ Thank you for sending your receipts and your bank details after the congress to :registration@gestmsk.com We will proceed to your refund by bank transfer within 4 weeks after the conference depending of your departure country. If you use your personal vehicle, the allowances of refund will be calculated on a standard kilometers referral. GDPR* By clicking on « SEND », you confirm that you have read our Privacy Policy and you agree that the company COM&CO EVENTS and its partners process your personal data, in accordance with the aforesaid Policy, regarding your request for a grant support.PhoneCe champ n’est utilisé qu’à des fins de validation et devrait rester inchangé. Δ CONTACTMrs Sacha Meynard for GEST MSK Registration registration@gestmsk.com