Registration Health Care Specialists Stand up for your feet! Registration Form Personal Information Title First Name* Family Name* Profession* Profession* Medic Specialist Medic Rezident Fizioterapeut (Kinetoterapeut/ Fiziokinetoterapeut/ Balneofiziokinetoterapeut/ Profesor CFM) Asistent Medical / Asistent medical licentiat Farmacist Podiatru Psiholog Manageri din domeniul medical Specialization Specialization* Anestezie si terapie intensiva Boli infectioase Cardiologie Chirurgie cardiaca si a vaselor mari Chirurgie dento-alveolară Chirurgie generala Chirurgie plastica si reparatorie Chirurgie toracica Chirurgie vasculara Dermato-venerologie Diabet zaharat, nutritie si boli metabolice Endocrinologie Farmacie generala Farmacologie clinică Gastroenterologie Geronto-geriatrie Ginecologie Hematologie Medicina de familie Medicina de urgenta Medicina interna Medicina muncii Nefrologie Neurochirurgie Neurologie Neurologie pediatrica Oftalmologie Oncologie medicala Ortodonție Ortopedie Ortopedie pediatrica Otorinolaringologie Pediatrie Pneumoftiziologie Psihiatrie Psihiatrie pediadrica Reabilitare medicala Reumatologie Stomatologie CUIM/Personal Number (CNP)* Workplace Country* Country* Romania Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of The Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic Of Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People'S Republic Of Korea, Republic Of Kuwait Kyrgyzstan Lao People'S Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic Of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Russian Federation Rwanda Saint Helena Saint Kitts And Nevis Saint Lucia Saint Pierre And Miquelon Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia And Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province Of China Tajikistan Tanzania, United Republic Of Thailand Timor-Leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis And Futuna Western Sahara Yemen Zambia Zimbabwe Address* Postal Code* City* Email Address* Phone Terms and Conditions Sunt de acord cu prelucrarea datelor cu caracter personal furnizate mai sus în vederea participării la evenimentele organizate de Worwag Pharma Romania, proces care se va desfășura în strictă conformitate cu Politica Evenimente Pentru Sănătate. I agree with the processing of personal data provided above in order to participate in the events organized by Worwag Pharma Romania, a process that will be carried out in strict accordance with the Evenimente Pentru Sănătate Policy. Vă informăm că la acest eveniment se realizează fotografii și videoclipuri live de către echipa Evenimente Pentru Sănătate și fotografi profesioniști contractați. Acestea vor fi făcute publice pe diversele canale de comunicare (online și print) al Worwag Pharma Romania. Prin participarea dvs. vă exprimați acordul de a publica aceste fotografii și videoclipuri. We would like to inform you that at this event live photos and videos are being taken by the Evenimente Pentru Sănătate team and contracted professional photographers. These will be made public on the various communication channels (online and print) of Worwag Pharma Romania. By participating, you agree to publishing these photos and videos. Send
