Research Talent Academy

Registration date

Personal details

Last name

First name

Title

Gender

Date of birth

Country of birth

Specialty of interest

Resident in training

yes. If yes, when do you expect to complete your surgical training?
no. If no, when did you complete your surgical training?

Date:

Hospital / Institute

Department

Street

Postal code

City

Country

Telephone

Mobile

Email

CV

Protocol

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