International CTEPH Association

Kindly complete your registration by providing the details below.

Personal & Professional:

Last Name:

Boon

First Name:

Gudula

Middle Initial:

J.A.M.

Hospital / Institution / Company:

Leiden University Medical Center

Position:

MD PhD student

Address:

e-Mail:

g.j.a.m.boon@lumc.nl

Street and House Number:

Albinusdreef 2

City:

Leiden

Zip Code:

2316VR

State:

Country:

The Netherlands

Membership benefits:

agree with your name and institution:

Site Information:

program for the treatment:

Yes

program set up:

currently taken care:

patients operated:

approximate number:

normally referred: