To register your interest, please make sure that your membership is active and state your personal details below.

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* 1. I understand this survey is only for those with a trainee membership and I have a current, valid, ESVS trainee membership

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* 3. First Name:

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* 4. Last Name:

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* 5. Title / Position / Occupation:

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* 6. Department / Hospital / University / Institute:

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* 7. City:

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* 8. Country:

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* 9. Telephone number incl. country and area code:

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* 10. E-mail:

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* 11. Which course are you interested in? (please select all that apply)

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* 12. I give permission for ESVS to pass on my details to the event organisers I have selected above.

Thank you for your interest in ESVS & EVST third party membership benefits.

The office will soon be in touch with further details.

Best wishes,

The ESVS Team

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