MLCTO 2019 – NICE – June 27th to 29th – PRE-REGISTRATION MLCTO 2019 – NICE – June 27th to 29th – PRE-REGISTRATION https://form.comnco.net/wp-content/uploads/2018/06/Capture-d’écran-2018-06-07-à-10.01.32.png 489 583 Com&Guest Com&Guest https://form.comnco.net/wp-content/uploads/2018/06/Capture-d’écran-2018-06-07-à-10.01.32.png 19 juin 2018 19 juin 2018 PRE-REGISTRATION - MLCTO 2019 - NICE - JUNE 27th-29th Family name*First name*E-mail adress*Date of birth*Cell phone number*Affiliated Medical Center*City*Country*Please indicate your RPPS Number*I would like to pre-register as :*PhysicianFellowParamedicsWhat do you perform in your daily practice ?* Coronary angioplasty Peripheral angioplasty Structural heart interventions Rhythmology Interventional radiology Vascular surgery Cardiac surgery How many percutaneous coronary interventions are performed per year in your center?*How many CTO PCI have been performed during 2018 in your center?*How many CTO PCI did you personally perform during 2018 ?*How many CTO PCI do you consider personally to perform in 2019 ?*Did you participate to one of the previous ML CTO Editions?*YesNoHow have you heard about the ML CTO Course? Newsletter Website (browser) Brochure Industry Peer Please indicate which industry and country ?Please indicate the name of your colleague ?What are the reasons why you want to attend this Course?*Personal data* By sending this form, I agree that my personal data might be used for the purposes of my logistic arrangements by the company or any service providers that may need it. NameCe champ n’est utilisé qu’à des fins de validation et devrait rester inchangé.