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Registrationform SMPE/e course 'PPMT 2025'
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Masterclasses voor Technologen in de zorg
Physics and Physiology behind Medical Technology
Registrationform SMPE/e course 'PPMT 2025'
Required fields are marked with an asterisk (*)
Personal data
Surname (family name)
*
Insertion (e.g. 'van' or 'van der')
Firstname
*
Initials
*
Title
Gender
*
M
F
Date of birth (for certificate): e.g. July 1, 1994
*
Place of birth (for certificate)
*
Telephone number (preferably mobile in case of last minute changes in programme)
*
Contact data
E-mail
*
Street and number of private address
*
Postal code + city of private address (e.g. 5600 MB Eindhoven)
*
Name hospital/company/institution
*
Street and housenumber from hospital/company/institution (no postbox)
*
Postalcode and + city of hospital/company/institution
*
Position
*
Department
*
I am (in training as) a
Clinical Physicist (i.t.)
QME i.t.
CI i.t.
e/MTIC EngD, PhD, Postdoc
AIO
Other
If other, please write down your field of training or work
Courseregistration
Coursedates: September 15-16-17, September 29-30 + *Comeback Day on November 24, 2025
*All Options are with Comeback Day
I want to subscribe for:
6-days course*
September 15-16-17, September 29-30 + *Comeback Day on November 24, 2025
Block 1: 4-days course*
September 15-16-17 + *Comeback Day on November 24, 2025
Block 2: 3-days course*
September 29-30 + *Comeback Day on November 24, 2025
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*
Homeaddress
Hospital/company/institution
果冻传媒 (I am a CI/QME/PhD trainee)
Costcenter/Projectnumber/Activitynumber/Ordernumber/Reference number (with home address-not applicable) 果冻传媒 trainees: please fill in your activity number. Thank You!
*
Outside 果冻传媒? Please fill in the Financial email address of the department for Billing procedures ('Crediteuren administratie')
Dietwishes
Course expectations
What do I expect from this course (day)?
*
Attention: If you have not received a confirmation of registration by email please check your SPAM folder and notify smpee@tue.nl directly. Thank you!
Don't fill this field!
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