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Registration form PhD
First name
*
Last name
*
Full Academic title
*
Professional title
Organisation / company
*
Department
Address
City
State / Province
Postal / zipcode
Country
Mobile phonenumber
(including country code + 31 6....)
*
E-mail address
*
Upload a document in which the department head confirms the status of doctoral student (PhD)
*
I give permission to share my e-mail address with the research team of the Amsterdam UMC for research purposes related to preterm birth.
*
Yes
No
I hereby agree to the
terms
of ESPBC 2023. And buy a ticket of € 500.-
*
Yes
*
=
Input is required
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