Complete Conference Management, a division of UMA Education, Inc.

PNEC 2021

May 27, 2021 | Hyatt Regency Seattle | 808 Howell Street | Seattle, WA  98101

Correo electrónico de confirmación perdido? Haga clic aquí para volver a enviar.

Información Personal

Nombre: *

Apellido: *

Centro Médico / Hospital / Empresa: *

Are you employed by a hospital-based or a private practice?:*(Please select one)

Hospital-Based Practice Private Practice Other

title *

Título: * (seleccionar un máximo de dos designaciones)

Usted puede seleccionar un máximo de dos designaciones.

Dirección: *

Dirección 2:

Ciudad: *

ESTADO/PROVINCIA: *

Código Postal: *

Correo electrónico: *(Format: email@domain.com)

Teléfono (Día): *(Format: XXX-XXX-XXXX)

Celular: *(Format: XXX-XXX-XXXX)

País: *

Confirmar correo electrónico: *(Format: email@domain.com)

Secundaria Correo electrónico: (Format: email@domain.com)

Secundaria confirmar Correo electrónico: (Format: email@domain.com)

Confirmacion y el certificado de asistencia sera enviado al correo electronico indicado en este formulario.

Información Profesional

:*(Please select one)

    	    
Physician
    	    
Nurse or Allied Health Professional
    	    
Senior Fellow or Resident (PNEC & Simulation Summit)
    	    
Resident (Competition-Invitation Only)
    	    
Fellow or Resident (PNEC Only)
    	    
Student
    	    
Industry or Non-clinical

Estado Licenciado (EEUU): *

Estado Licenciado 2 (EEUU):

Número de licencia medica (EEUU): What is this

Servicios Especiales (ADA) Y Restricciones en la dieta:What is this

IMPORTANT NOTE:
SENIOR FELLOWS (PNEC & SIMULATION SUMMIT):

Only Senior Fellows in Cardiothoracic, Peripheral Intervention or Vascular specialties may register to attend both the Simulation Summit and PNEC at no charge and with the opportunity for travel reimbursement.
FELLOWS & RESIDENTS (PNEC ONLY):
Fellows and Residents are welcome to attend PNEC on Friday, May 28, 2021, at a discounted registration rate. Simulation Summit is NOT included.
RESIDENTS (COMPETITION ONLY BY INVITATION):
Only residents from invited institutions may register for PNEC using this category. Simulation Summit is NOT included.

Más Información

¿Cual fue la razon principal que contribuyó a su decisión de asistir a este simposio? *

¿Requiere una carta de invitacion para fines de Visa?

HAVE YOU ATTENDED PNEC IN THE PAST?

Yes No

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Grupo de Edad*

Código de Descuento

Cuotas de Inscripción

Description de Cuota TOTAL
Cuota de inscripción:
None
Additional Fee:
Código de Descuento
Total a Pagar: