Course registration form

Enrol in Patient Safety

Use this form to enrol in the course Patient Safety in Clinical and Resource-Poor Settings .

The price for this course is 80.00 Euro.

Basic Data

Email*

First name*

Last name*

Birth date*

Job title/Function*

Organisation*

I agree with the Data Policy*

I give permission to use my email address to use and contact me with for any marketing purposes, printed or online

I give evaplan GmbH and the Heidelberg Institute of Global Health (HIGH), University of Heidelberg, my permission to use my email address to use and contact me with for any marketing purposes, printed or online.

If I wish to retract my permission, I will contact the Heidelberg Institute of Global Health (HIGH) in writing immediately.

I give permission to use my photo/video/audio

I give evaplan GmbH and the Heidelberg Institute of Global Health (HIGH), University of Heidelberg, my permission to use any photos and / or video and audio footage of me for all marketing and internal purposes, printed or online.

With my permission, I am aware that any photos / video and audio footage of me may be used in the following printed and online media:

All internet pages associated with the Institute, it projects and the University
All publications (printed or online)
Brochures, flyers, posters (printed or online)
Facebook pages, Twitter and all other social media sites associated with the Institute, its projects and the University
Alumni publications (printed or online)
Internal documents and publications (printed or online)

If I wish to retract my permission, I will contact the Heidelberg Institute of Global Health (HIGH) in writing immediately.

Invoice

I require an Invoice*

Yes

Company / Organisation

Name

Country

Address

Postal Code

City

Course Registration

How did you learn from us?

Important Information about this order:

Terms & Conditions Apply
All the courses are offered on behalf of the Heidelberg Institute of Global Health, University Hospital Heidelberg, and therefore are excluded from VAT.

Credit Card:

Reason for Payment: D.100 551 81, your name + course title
You will receive the link through email!

Bank Transfer:

Beneficiary: evaplan at the University Hospital Heidelberg

Bank: Sparkasse
IBAN: DE29 6725 0020 0009 1003 18
Notation/ Reference: D.100 551 81, your name + course title
Postal Address: Ringstrasse 19b, 69115 Heidelberg, Germany

Important: Please use our internal notation D.100 551 81, your name and the course title as a payment reference.

Invoices can be issued upon request to: sekretariat@evaplan.org