Signup form – ORL DISSECTION EAR AND TEMPORAL BONE SURGERY, 27. 11. - 29. 11. 2018

I hereby request the sending of professional training offers, namely seminars and courses organized by the Educational Center for Practical Anatomy s.r.o. Ltd., ID: 04616081, based in Brno, Bratří Čapků 4, 602 00 and to that end I hereby give my consent to processing of my personal data, including my name, surname, and email address.

I acknowledge that my personal data provided on the basis of this consent will only be processed to the extent necessary solely for the purpose of sending offers of professional seminars and courses currently organized by the Educational Center for Practical Anatomy s.r.o. (Ltd.), or sending information regarding the organization of a particular seminar or a course, of which I have expressed interest.

I confirm that I have thoroughly read the contents of the Privacy Policy created by the Educational Center for Practical Anatomy s.r.o. (Ltd.), which is available here.

I acknowledge that I can withdraw from my consent at any time and without giving any reason by sending an email to info@ecpa-cz.com.


Affirmation of preventive vaccination

I declare that I am appropriately vaccinated against diseases according to the Decree of Healthcare Ministry of the Czech Republic no. 537/2006 Coll. of 8th December 2006 – Decree on vaccinations against infectious diseases - which could be transmitted to me from biological material during the course. I commit myself to use protective aids which are specified by the course organizer. Thereby I relieve the organizer from responsibility in case of any health damage during the course.

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