Registration Form

Name and Surname (required)

Date of birth (required)

Place of birth and province (required)

In service at (required)

With the qualification of (required)

Email (required)

Calls for membership of the Section of Endoscopic, Minimally Invasive and Pediatric Robotics of the Italian Society of Pediatric Surgery.

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Address of residence - Please indicate street, city, cap, province (required)

Mobile Phone (required)