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Participant Information
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For new laboratories joining NordiQC
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Address for invoice (if
not participant address);
Name/attention (if needed) |
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Hospital *
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Hosp./Institution |
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Departm./laboratory
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Name/Attention |
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Address *
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Address |
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Address (ct.) |
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Address
(ct.) |
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Zip and City *
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Zip and City
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Country * |
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Country
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Names: |
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Contact person 1*
Name on the slide mails |
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E-mail 1* |
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Contact person 2
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E-mail 2 |
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Contact person 3 |
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E-mail 3 |
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Contact person 4 |
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E-mail 4 |
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Participation:
(tick
one or two boxes)**
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General Module
Breast Module
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To ensure the communication it is recommended to indicate
3-4 e-mail
addresses.
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Comments*** |
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UIN / UID no.:
EAN no. (DK): |
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* Fields required.
** Tick the box if you plan to participate in the module.
It is not binding: Participation is only charged when
you submit protocols.
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e.g., special information needed on the invoice; special subscription terms; sponsored
participation.
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