ERTC Quality Label - Renewal applications

ERTC ID number (provided during the first application)

Contact person (NAME in capital letters & Surname in small letters)

The name will be published on our website next to the Training Centre's name.

ESC ID of the contact person

The contact person should create its own account via MyESC platform providing clear, valid and complete contact details: https://escol.escardio.org/MyESC/modules/User/register_step1.aspx

Contact person email address

The e-mail will be published on our website next to the Training Centre's name.

Contact person phone number

Name of the Centre

This name should be the same as on your Quality Label certificate. However please write the updated name if changes occured.

This name will be automatically written on your certificate of renewal.

City of the Centre

Country of the Centre

Website of the Centre (if any)

Please indicate if the Centre is

Please indicate the type of the Centre

Please describe the training facilities and expertise of the Centre

(150 words maximum)

Please select the modality/ies of your previous ERTC Quality Label

Please provide previous ERTC Quality Label certificate(s) in the "File Attachments" section at the end of the document

Start & end dates of your previous ERTC Quality Label

Renewal

EP & CP

I. Staff Centre Requirements

II. Centre Participation Requirements

5.a. Please confirm if the number of Training Fellows in the Centre allows each of them to fulfill the requirements of the EHRA logbook for certification

5.b. Please confirm that the Centre allows its enrolled Training Fellows to visit at least one EHRA event (endorsed course, meeting, EHRA congress, etc.) per year

5.c. Please confirm that the Centre will encourage its enrolled Training Fellows to pass the EHRA certification exams

III. Information about Centre

IV. Centre Fellow's Participation Requirements

Please provide information on at least 2, maximum 4 Fellows which has been starting their training at your Centre during the past 4 years.

Fellow 1 - Title

Fellow 1 - Full name

Fellow 1 - ESC ID

Fellow 1 - Email address

Fellow 1 - Training Fellowship starting date

included between past 4 years and today

dd/mm/yyyy

Fellow 1 - Training Fellowship ending date

dd/mm/yyyy

Fellow 2 - Title

Fellow 2 - Full name

Fellow 2 - ESC ID

Fellow 2 - Email address

Fellow 2 - Training Fellowship starting date

included between past 4 years and today

dd/mm/yyyy

Fellow 2 - Training Fellowship ending date

dd/mm/yyyy

Fellow 3 - Title

Fellow 3 - Full name

Fellow 3 - ESC ID

Fellow 3 - Email address

Fellow 3 - Training Fellowship starting date

included between past 4 years and today

dd/mm/yyyy

Fellow 3 - Training Fellowship ending date

dd/mm/yyyy

Fellow 4 - Title

Fellow 4 - Full name

Fellow 4 - ESC ID

Fellow 4 - Email address

Fellow 4 - Training Fellowship starting date

included between past 4 years and today

dd/mm/yyyy

Fellow 4 - Training Fellowship ending date

dd/mm/yyyy

File Attachments (ERTC Quality Label certificate, ...)

Drop your files here

Centre Billing Information

Please check with your Finance Department and indicate the following information in the fields below

• the billing Centre’s address that must appear on the invoice

• the Centre’s VAT number if it has one (2/4 letters + numbers)

• the Centre's PO (Purchase Order) number if you have one.

WARNING : Please note that the invoice will be edited and sent only ONCE. So make sure that all the billing information provided below is correct. No invoice modification will be made. Thank you.

Centre's billing exact name and address

Centre's VAT number/ID (letters + numbers)

Centre's Purchase Order number (if any)

Acceptance and Conditions

PERSONAL DATA PRIVACY The information collected is subject to a computerized process to record, and track your centre application. The recipients of the data are:

• The staff in charge of processing "EHRA Recognised Training Centre" applications

• Persons to whom the request will be sent for review and evaluation

In accordance with the French law N°78-17 of January 6,1978, amended in 2004, relating to the protection of individuals with regard to the processing of personal data, you have the right to access and rectify information concerning you, which you can exercise by contacting:

Customer Services

European Society of Cardiology

Les Templiers, 2035 Route des Colles

CS 80179 Biot

06903 SOPHIA ANTIPOLIS CEDEX, FRANCE.

You can also, for legitimate reasons, oppose the processing of data about you.

I've uploaded the letter of support from my EP National Cardiac Society / Working Group.

I've uploaded the previous Quality Label certificate that my Centre obtained

I confirm that I have read and answered accurately and correctly the EHRA Recognised Training Centres requirements to the best of my knowledge and belief

Send me a copy of my responses

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