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LATIN AMERICAN CENTER FOR THE

RESEARCH AND TRAINING ON


MINIMALLY INVASIVE SURGERY. CLEMI

APPLICANT COMPANY
NAME OF THE APPLICANT OFFICIAL
POSITION OF THE APPLICANT OFFICIAL
LANDLINE or CELL PHONE OF THE APPLICANT OFFICIAL
E - MAIL APPLICANT OFFICIAL
NAME OF THE ACTIVITY
DATE PLANNED FOR THE REALIZATION OF THE ACTIVITY
SURGICAL SPECIALTY
NUMBER OF PARTICIPANTS
DIRECTOR OF ACTIVITY
ASSISTANTS AS SUPPORT INDUSTRY (INSTRUMENTATORS / TECHNICIANS)
REQUIRES COMMERCIAL STAND ?
WORK STATIONS REQUESTED ? (Number of corpses)
DURATION OF THE ACTIVITY (DAYS)
REQUIRES CONFERENCE ROOM ?
DOES THE CADAVERES REQUIRE PREPARATION? (SHORT DESCRIPTION)

REQUIRES

TRANSPORT

UNIFORMS

  STATIONERY

SPECIALIZED EQUIPMENT

SPECIALIZED INSTRUMENTAL

OTHERS
If you would like additional information about the deve
clemi@clemi.edu.
Cell Phone: 57 +1 318 7352834- B
ACTIVITY APPLICATION FORMAT

Código: PO-C-F41 Consecutive:

YES: NO:

YES: NO:

DETAIL YES or NO / SPECIFICATIONS

GOING, RETURN or NONE

SURGICAL UNIFORMS (WITH LOGO CLEMI,


ADDITIONAL LOGO, EMBROIDERY, etc.)

COCKADE - TALKATIVE- CERTIFICATE (Logo


industry, scientific society, CLEMI)

TOWERS OF ENDOSCOPY, ARTHROSCOPY,


ECOGRAPHY, Rx, ETC

SPECIALTY
out the development of your activity, please contact:
@clemi.edu.co
8 7352834- Bogotá, Colombia.

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