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Application for admission as a full member to the Swiss Society for Phlebology

Please fill in all the necessary fields!

Personal data
Last name *
First name *
Birthday
Nationality
Academic title     
   
Address / Workplace
Hospital / Practice
Street *
Postcode *
City *
Phone
 
Adresse Privat
Street *
Postcode *
City *
Phone
Email *
 
Medical/other academic degree (Date, University, Country)*

 
FMH title *





Function *
Sponsors on admission to membership
Sponsor 1
Sponsor 2
* Required fields
Please send your CV and a written recommendation from your two sponsors (SGP members) together by email to: usgg@meister-concept.ch


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