Request for a grant support - April 24th -26th Prague, Czech Republic SEUD 2025 | Com&Co Form

Request for a grant support – April 24th -26th Prague, Czech Republic SEUD 2025

Request for a grant support – April 24th -26th Prague, Czech Republic SEUD 2025 https://form.comnco.net/wp-content/themes/movedo/images/empty/thumbnail.jpg 150 150 Com&Co Form Com&Co Form 22 octobre 2024 22 octobre 2024

REQUEST FOR A GRANT SUPPORT

Request for grant support - April 24th to 26th - SEUD 2025

Family name*
First name*
E-mail address*
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*
EVALUATION
Have you submitted an abstract into our platform?*
- Yes
- No
TITLE OF THE ABSTRACT*
What is your professional activity/position?*
- Physician/Resident
- Physician/Attending
- Physician/Chief of department
- Biologist
- Nurse
Where do you hold your primary professional activity?*
- Private non-teaching institution
- Private teaching institution
- Public non-teaching institution
- Private teaching institution
- Other
Primary professional activity center*
Which is your main field of interest?*
- Endometriosis
- Adenomyosis
- Fibroids
- AUB
- Fertility
How would you define yourself?*
- Clinician
- Surgeon
- Imaging expert
- Fertility doctor/biologist
- Basic researcher
- Epidemiologist
- Pain expert
PRE COURSE CONGRESS
Do you want to participate to one of the Pre-Congress Course*
- Yes
- No
Pre-Congress Courses*
- Pre-Congress Course : AUB
- Pre-Congress Course : Infertility
- Pre-Congress Course : Imaging
- Pre-Congress Course : Office Hysteroscopy
SOCIAL PROGRAM
Gala dinner*
- Yes, I take part to the gala dinner
- I will be accompanied by one person (65€)
- No, I do not take part to the gala dinner
65€/person. 8:30 PM. Place to be confirmed.
INVOICE ADDRESS
Phone
Ce champ n’est utilisé qu’à des fins de validation et devrait rester inchangé.

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CONTACT

Registration

registration@seud.org
15 boulevard Grawitz
13016 Marseille

© Com&Co Events - Professional Congress Organizer (PCO)

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