Formulaire

Academy EEG

Personal data

Title

Academic title

Firstname

Please fill in your firstname

Lastname

Please fill in your lastname

FMH-Title (if exists)

Please fill in your specialist title

Birthdate

Please fill in your birthdate

Address

Please fill in your address

Zip code

Please fill in your zipcode

City

Please fill in your city

Country

Correspondence language

Mobile phone

Please fill in your mobile phone number

E-mail

Please fill in your email and check the format (e.g. example@example.com)

Address company

Please fill in the address of your company

Zip code company

Please fill in the zipcode of your company

City company

Please fill in the city of your company

Company: Country

Are you a member of the SGKN?

Yes

Please tell us if you are or are not a member of SGKN

Would you like to become a member of the SGKN?

Yes

Please tell us if you want to become a member of SGKN

Letter from patron

Upload patron letter 1Remove Please upload the recommendation letter of your patron in allowed file format

Curriculum Vitae

Upload curriculum vitaeRemove Please upload your curriculum-vitae in allowed file format

DOC/DOCX/ODT, XLS/XLSX/ODS, PDF, PNG, JPG/JPEG

Are you a member of SAYN?

Yes

Please tell us if you are or are not a member of SAYN

Proof of SAYN membership

Upload proof of SAYN membershipRemove Please upload your proof of SAYN membership

DOC/DOCX/ODT, XLS/XLSX/ODS, PDF, PNG, JPG/JPEG