| Institut für Rechtsmedizin

Form

I register for* *

Module 0 / facultative - Module 0, CHF 450.-- (booked together with Module I)

Module 0 / facultative - Module 0, CHF 650.-- (booked as stand alone Module)

Module I - Virtopsy Basic Course, CHF 1'300.--

Module II - Virtopsy Advanced Course, CHF 1'900.--

Module III - Virtopsy Practical Course, CHF 7'300.--

Academic title *

First Name *

Last Name *

Profession *

Institution *

Street *

City / ZIP code *

Country *

E-Mail *

Phone *

Short CV*

( Please note the mandatory field and be sure to attach the //file//.)

Diplomas*

( Please note the mandatory field and be sure to attach the //file//.)

Passport copy*

( Please note the mandatory field and be sure to attach the //file//.)

Does the address given correspond to the billing address?* *

Yes

If not, please advise complete billing adress

Institut für Rechtsmedizin