EHRA AP Pre-exam questionnaire - Bologna 2017

Dear candidate, PLEASE READ CAREFULLY: Thank you for your interest in the EHRA AP Italian certification exam that will take place on 25 March 2017 Bologna (Italy). In order to go to the payment process and finalize your application to registrate, please complete the following questionnaire and click on "submit" at the bottom of the page. You will then be redirected to a new page to submit your payment. Your payment confirmation and invoice will be sent to your email address within the next few days. (Please make sure the email address you have provided in your MyESC account is up to date). Registration confirmation and logistical information will be sent within a few weeks.

ESC ID*

Mind that certificates will be issued upon information given in your MyESC profile (name and last name spelling…) If needed, update your MyESC profile (https://escol.escardio.org/MyESC/login.aspx?ReturnUrl=%2fMyESC%2fmodules%2fdashboard%2fdefault.aspx)

First Name*

Last Name*

Country*

Select or enter value

Email*

Make sure it is the same as in your MyESC profile.

Supervisor’s Name*

Your supervisor is someone recognised for his/her experience in Cardiology. He/She can be your chief, head of department,etc. Someone who can confirm your experience. Do not write your name otherwise your registration will not be validated.

Supervisor’s Email*

Do not write your e-mail otherwise your registration will not be validated.

Please indicate the reason you will be in Bologne*

Select or enter value

Indicate your educational background*

Select or enter value

If Other educational background, specify

Indicate your professional profile*

Select or enter value

If Other professional profile, specify

Did you attend the EHRA Educational Courses?*

Select or enter value

Did you attend one or several EHRA webinars?*

Select or enter value

If yes, how many?

Select or enter value

Next Steps

You will be redirected to a new page to submit your payment. Your payment confirmation and invoice will be sent to your email address within the next few days. (Please make sure the email address you have provided in your MyESC account is up to date). Registration confirmation and logistical information will be sent within a few weeks. You will receive your boarding pass around 10 days prior to the exam.

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