Pizza with a Prof Registration

Title:

—Please choose an option—Mr.Mrs.

Prefix:

First Name:

Surname:

Clinic/Organisation:

City:

Phone:

Email:

Message:

Please select your discussion partner:

1st choice:

—Please choose an option—Prof. Dr. Nikolaos Bechrakis, InnsbruckProf. Dr. Nicole Eter, MünsterProf. Dr. Gerd Geerling, DüsseldorfProf. Dr. Franz Grehn, WürzburgProf. Dr. Rudolf Guthoff, RostockProf. Dr. Horst Helbig, RegensburgProf. Dr. Antonia Joussen, BerlinProf. Dr. Birgit Lorenz, GießenProf. Dr. Norbert Pfeiffer, MainzProf. Dr. Berthold Seitz, Homburg/SaarProf. Dr. Hagen Thieme, MagdeburgProf. Dr. Ueffing, Tübingen

2nd choice:

—Please choose an option—Prof. Dr. Nikolaos Bechrakis, InnsbruckProf. Dr. Nicole Eter, MünsterProf. Dr. Gerd Geerling, DüsseldorfProf. Dr. Franz Grehn, WürzburgProf. Dr. Rudolf Guthoff, RostockProf. Dr. Horst Helbig, RegensburgProf. Dr. Antonia Joussen, BerlinProf. Dr. Birgit Lorenz, GießenProf. Dr. Norbert Pfeiffer, MainzProf. Dr. Berthold Seitz, Homburg/SaarProf. Dr. Hagen Thieme, MagdeburgProf. Dr. Ueffing, Tübingen

Would you like to be assigned to another discussion partner if the selected aren't available?

YesNo