NeuroMuscular Taping LYMPHATIC ONLINE Course PRE-Registration Form

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The following information is required by the NeuroMuscular Taping Institute for the purposes of PRE-registration and certification of the course that you have elected to attend. The information is to be used solely by the NMT Institute and will not be shared with persons having commercial interests. Any information that we send will relate to activities of the NMT Institute and services offered by us and our partners in the area of training, education, development and research.

ONLINE NMT LYMPHATIC Course
11,12 June & 2, 3 July 2021
Exam 17 July 2021

This is a PRE REGISTRATION form. You will be sent information regarding the course to the contact details listed below. Please fill in your details and send this form as indicated "SUBMIT"

Email *

Participant Name *

Participant Surname *

Your mobile phone N° (indicate country code and number) *

Please state your country *

What is your Profession? *

Medical doctor - neurologist

Medical doctor - lymphologist/angiologist

Medical doctor - sports medicine

Medical doctor - rehabilitation

Lymphatic drainage specialist

Physical therapist

Nurse

Occupational therapist

Student

Other:

Professional Working Area *

Public Hospital or clinic

Private Hospital or clinic

University Clinic

Private practice

Other:

The above Personal Data will be collected for the following purposes: NMT Institute course preparation and certification. We will adopt and maintain a policy that complies with all applicable privacy laws European General Data Protection Regulation (Regulation (EU) 2016/679). You acknowledge that all personal information that you provide to us has been collected with the relevant individual’s consent, and that you have been informed of the purpose for which that information was collected, and that you may provide this information to us for the purposes of use in relation to registration with the NMT Institute. You acknowledge that we may store the personal information that you provide to us on servers, and you warrant that you have obtained the consent of the relevant individuals to the storage and transmission of their personal information in this manner. *

Yes I give my consent

No I do not give my consent

Send me a copy of my responses.

Submit

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