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Application Form Advanced and ATCO AME Course 2023
Advanced and ATCO AME course
Monday 5th of June till Friday 16th of June
ISVW
Dodeweg 8
3832RD Leusden
The Netherlands
AMEcursus@nvvlg.nl
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Email
*
Your email
Name
*
Please fill in your complete names here (as stated in your Passport)
Your answer
Address (street, zipcode, city, country)
*
Your answer
Phone Number
Your answer
BIG-nummer/Medical Registration Number
*
Your answer
Area of Expertise
*
Basic doctor
General Practitioner
Occupational Physician
Cardiologist
Internist
Neurologist
Psychiatrist
Other:
Which course do you want to attend?
*
Advanced AME Course
ATCO AME Course
Both
Which AME Course have you previously completed?
*
None
Basic AME Course
Advanced AME Course
ATCO AME Course
Required
Are you registered as AME
*
Yes, AME Class 1
Yes, AME Class 2 + LAPL
Yes, AME Class 3
No
Required
If yes, what is your AME registration number?
Your answer
Dietary Requirements
*
None
Vegetarian
Vegan
Kosher
Glutenfree
Other:
Group dinner
The first Wednesday of the course (the 7th of June) we will organise a complimentary group dinner. This dinner provides an excellent opportunity to share experiences with like-minded
colleagues
.
Will you attend the group dinner?
*
Yes
No
Maybe
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