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Formulario de Inscripción
Favor llenar el formulario de inscripción al 1er. Congreso Médico Rotario y ramas afines.
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Email
*
Your email
Nombre completo
*
Your answer
Club Rotario o Rotaractiano (Si es que no es rotario, favor rellenar con "no rotario")
*
Your answer
Distrito Rotario (Si es que no es rotarios, favor rellenar con "0" cero)
*
Your answer
Cargo en Rotary (gestión 2021-2022)
Your answer
Teléfono de contacto
*
Your answer
Profesión
*
Your answer
Especialidad
Your answer
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