EPNS Exam 20 June 2023 REGISTRATION FORM

You are registering to participate in the EPNS Exam which will take place at 2pm CET on 20 June 2023 in-person only in Prague, Czech Republic, prior to the Opening Ceremony of the EPNS Congress https://epns-congress.com/
Questions about the EPNS Exam registration process should be sent to info@epns.info

All fields marked (*) are mandatory.

Please select one of the following. If you DO NOT meet one of these categories, you are not eligible to participate in the EPNS Exam : (*)
---I am a residents/trainee in Paediatric Neurology with at least 2 years of training AND I am a qualified physicianI am registered as a specialist Paediatric Neurologist AND I currently practice in the field of Paediatric Neurology

How many years have you been training in Paediatric Neurology? (*)
---not applicable, I am a registered Paediatric Neurologist2 years3 years4 years5 yearsmore than 5 years

How many years have you been practicing Paediatric Neurology? (*)
---not applicable I am a resident/trainee2 years3 years4 years5 yearsmore than 5 years

Title (*)
---Ass ProfDozDrProfProf DrMsMr

First name (*)

Last name (*)

Email (*)

Work Address first line (*)

Work Address City (*)

Work Address Zip Code (*)

Country (*)
---AFGHANISTANÅLAND ISLANDSALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTARCTICAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA AND HERZEGOVINABOTSWANABOUVET ISLANDBRAZILBRITISH INDIAN OCEAN TERRITORYBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACAPE VERDECAYMAN ISLANDSCENTRAL AFRICAN REPUBLICCHADCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLANDSCOLOMBIACOMOROSCONGOCONGOTHE DEMOCRATIC REPUBLIC OF THECOOK ISLANDSCOSTA RICAIVORY COASTCROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND ISLANDS (MALVINAS)FAROE ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAFRENCH SOUTHERN TERRITORIESGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUERNSEYGUINEAGUINEA-BISSAUGUYANAHAITIHEARD ISLAND AND MCDONALD ISLANDSHOLY SEE (VATICAN CITY STATE)HONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRANIRAQIRELANDISLE OF MANISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREA-DEMOCRATIC PEOPLES REPUBLIC OFKOREA-REPUBLIC OFKUWAITKYRGYZSTANLAO PEOPLES DEMOCRATIC REPUBLICLATVIALEBANONLESOTHOLIBERIALIBYAN ARAB JAMAHIRIYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIA-THE FORMER YUGOSLAV REPUBLIC OFMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIA-FEDERATED STATES OFMOLDOVA-REPUBLIC OFMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN MARIANA ISLANDSNORWAYOMANPAKISTANPALAUPALESTINIAN TERRITORY-OCCUPIEDPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRNPOLANDPORTUGALPUERTO RICOQATARREUNIONROMANIARUSSIAN FEDERATIONRWANDASAINT BARTHÉLEMYSAINT HELENASAINT KITTS AND NEVISSAINT LUCIASAINT MARTINSAINT PIERRE AND MIQUELONSAINT VINCENT AND THE GRENADINESSAMOASAN MARINOSAO TOME AND PRINCIPESAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAK REPUBLICSLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDSSPAINSRI LANKASUDANSURINAMESVALBARD AND JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIAN ARAB REPUBLICTAIWAN-PROVINCE OF CHINATAJIKISTANTANZANIA-UNITED REPUBLIC OFTHAILANDTIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLANDSTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATESUNITED STATES MINOR OUTLYING ISLANDSURUGUAYUZBEKISTANVANUATUVENEZUELAVIET NAMVIRGIN ISLANDS-BRITISHVIRGIN ISLANDS-U.S.WALLIS AND FUTUNAWESTERN SAHARAYEMENZAMBIAZIMBABWE

Are you a fully paid EPNS Member?(*)
---I am an EPNS member and I have paid my 2023 EPNS Membership fee.I am not an EPNS member

How will you be paying the EPNS Exam registration fee? Payment details will be sent in the automatic acknowledgement email.(*)
---debit/credit card via EPNS website (only EPNS members)bank transfer

I understand that to confirm my EPNS Exam registration, I must pay the EPNS Exam registration fee and complete, sign and return the EPNS Exam Proforma. (The EPNS Proforma can be found on the EPNS website. Email info@epns.info with enquiries).(*)

I accept and understand the EPNS Exam 2023 Terms and Conditions (see EPNS Exam Proforma section D) (*)

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