MEDICAL RETINA COURSE

Registration Form

Please fill out the registration form.
Fields marked with * are required.

First Name *

Last Name *

Email *

Password *

Date of Birth

Phone

Professional Category *

Institution *

Country of Residence *

Member of *

SPO Member Number *

Upload proof of ophthalmology practice *

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I understand and accept that my data will be used exclusively for the access and operation of the course as well as occasional communications regarding course content updates. *