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SMPE/e
Inschrijvingsformulier Wet en Regelgeving 2024
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Cursussen voor Technologen in de zorg
Wet en Regelgeving
Inschrijvingsformulier Wet en Regelgeving 2024
Required fields are marked with an asterisk (*)
Cursusinschrijving
Ik wil mij inschrijven voor
W&R 2024: donderdag 5 en vrijdag 6 september 2024
Persoonsgegevens
Achternaam
*
Tussenvoegsel/-s (van, van der)
Voornaam
*
Initialen
*
Titel
Geslacht
*
Man
Vrouw
Geboortedatum (i.v.m. certificaat): svp uitschrijven, bijv. 1 juli 1994
*
Geboorteplaats (i.v.m. certificaat)
*
Dieetwensen? (bijv. Glutenvrij, Notenallergie, Vegetarisch)
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*
Postcode
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Woonplaats
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Naam ziekenhuis of instelling
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Straat en huisnummer of postbus ziekenhuis of instelling
*
Postcode ziekenhuis of instelling
*
Woonplaats ziekenhuis of instelling
*
Functie
*
Afdeling
*
Ik ben in opleiding als
Klifio
QME i.o.
CI i.o.
AIO
HSD
Anders
Indien anders, te weten als:
Ik volg deze cursus in het kader van nascholing als
Klinisch Fysicus
Arts
Anders
Facturering
Factuur sturen naar
*
Huisadres
Ziekenhuis/instelling
TU/e (ik ben een CI/QME-trainee: dan wel Activiteitennummer noteren s.v.p.)
Anders
Kostenplaats-/referentie-/project-/ordernummer/overig (bij huisadres: NVT)
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Cursus verwachtingen
Wat verwacht ik van deze cursus?
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