Interest Registration

CONTACT DETAILS

Title

First Name

Last Name

Mobile

Email Address

Verify Email Address

Profession

If others, please specify

Current Role

Base specialty

Subspecialty

Current Employer

City of Practice

Country of Practice

No. of years since the highest qualification

REGISTRATION QUESTIONS

What is your current speciality?

If other, please specify

I consider myself

I have experience with

Do you currently work at a ECMO Centre?

I have performed ECMO cannulations?

Which ECMO machines do you currently use at your centre (or have used in the past)?

If you use multiple ECMO Machines, please type here

Other - please specify

How many patients receive ECMO at your centre annually?

Does your centre perform

Have you attended any ECMO workshop before?

If yes, please state which one

Are you planning to take the ELSO Adult ECMO Certification Exam?

If you answered yes to above question but you currently do not work at a ECMO centre, how do you intend to meet the clinical experience requirements for ELSO E-AEC certification?

Do you have any specific requests or information that could be helpful to the organizers [e.g., serious allergies, disabilities, dietary requirements, etc.?]

What are your expectations from this course?

- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Important Note

Comprehensive ELSO-endorsed Simulation-based ECMO Workshop has been designed to cover the curriculum specified by ELSO using the lectures, demonstrations, hands-on skills training, and immersive simulation scenarios for troubleshooting. Satisfactory completion of this course will satisfy the step 1 and 2 requirements towards the ELSO E-AEC certification. However, candidates are also expected to meet the minimum clinical experience requirement and pass the exam to get E-AEC certified. Please see the ELSO website for updated information.
Please also note that the course exclusively uses Getinge CardioHelp for all demonstrations, hands on, troubleshooting, and immersive simulations.

This is just a submission of interests only and does not confirm your official registration.
Selected HCPs will receive a separate notification with a payment link to complete and confirm their registration.

You need to enable JavaScript to access this site.

Follow these instructions on how to enable JavaScript.

Internet Explorer

Select Tools from the top menu
Choose Internet Options
Click on the Security tab
Click on Custom Level
Scroll down until you see the section labelled Scripting
Under Active Scripting, select Enable and click OK

Google Chrome

Select the menu icon on the browser toolbar
Select Settings
Click the Show advanced settings... link then Content Settings in the Privacy section
Select Allow all sites to run JavaScript (recommended) and click Done

Safari (Mac)

Select Safari from the top menu
Choose Preferences
Choose Security
Select the checkbox next to Enable JavaScript

Interest Registration

TERMS & CONDITIONS

Your Browser Settings have Cookies Disabled