{"id":1688,"date":"2024-05-03T09:40:34","date_gmt":"2024-05-03T07:40:34","guid":{"rendered":"https:\/\/semmelweis.hu\/short-courses\/?page_id=1688"},"modified":"2024-05-03T10:03:49","modified_gmt":"2024-05-03T08:03:49","slug":"contact-form","status":"publish","type":"page","link":"https:\/\/semmelweis.hu\/short-courses\/contact-form\/","title":{"rendered":"Registration"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1368-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1368\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/short-courses\/wp-json\/wp\/v2\/pages\/1688#wpcf7-f1368-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1368\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.5\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1368-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<p>Personal Details\n<\/p>\n<p><label> First name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Family name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"family-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"family-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Email*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Nationality*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nationality\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nationality\" \/><\/span> <\/label>\n<\/p>\n<p><label> ID\/Passport number*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"id-passport\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"id-passport\" \/><\/span> <\/label>\n<\/p>\n<p><label> Tax number*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tax\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tax\" \/><\/span> <\/label>\n<\/p>\n<p><label> Name of your University\/Clinic\/Institution*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-university\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-university\" \/><\/span> <\/label>\n<\/p>\n<p><label> Which course are you applying for?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-674\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-674\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Dental Course 01: Basic evaluation of wisdom teeth prior to removal\/ Surgery of third molars I\">Dental Course 01: Basic evaluation of wisdom teeth prior to removal\/ Surgery of third molars I<\/option><option value=\"Dental Course 02: Techniques of third molar surgery\">Dental Course 02: Techniques of third molar surgery<\/option><option value=\"Dental Course 03: Basics of sinus-lift surgery\">Dental Course 03: Basics of sinus-lift surgery<\/option><option value=\"Dental Course 04: Function of the temporomandibular joint. Diagnosis and therapy of TMD\">Dental Course 04: Function of the temporomandibular joint. Diagnosis and therapy of TMD<\/option><option value=\"Dental Course 05: Prosthetic Procedures For Fixed Restorations. From Impression Taking To Cementation.\">Dental Course 05: Prosthetic Procedures For Fixed Restorations. From Impression Taking To Cementation.<\/option><option value=\"Dental Course 06: Temporomandibular dysfunction and orofacial pain\">Dental Course 06: Temporomandibular dysfunction and orofacial pain<\/option><option value=\"Dental Course 07: Digitally enhanced esthetic dentistry\">Dental Course 07: Digitally enhanced esthetic dentistry<\/option><option value=\"Dental Course 08: Fundamentals of intraoral scanning\">Dental Course 08: Fundamentals of intraoral scanning<\/option><option value=\"Dental Course 09: Making of intraoral appliances. Manufacturing of intraoral Michigan type splints\">Dental Course 09: Making of intraoral appliances. Manufacturing of intraoral Michigan type splints<\/option><option value=\"Dental Course 10: Rubber dam isolation in Prosthodontics, fiber post core build-up\">Dental Course 10: Rubber dam isolation in Prosthodontics, fiber post core build-up<\/option><option value=\"Dental Course 11: Successful complete dentures: dos and don\u2019ts\">Dental Course 11: Successful complete dentures: dos and don\u2019ts<\/option><option value=\"Dental Course 12: Presentation Skills\">Dental Course 12: Presentation Skills<\/option><option value=\"Medical Course 01: Translational Medicine Basic Summer School in Person)\">Medical Course 01: Translational Medicine Basic Summer School in Person)<\/option><option value=\"Medical Course 02: Translational Medicine Advanced Summer School (in Person)\">Medical Course 02: Translational Medicine Advanced Summer School (in Person)<\/option><option value=\"Medical Course 03: Translational Medicine Advanced Summer School (Online)\">Medical Course 03: Translational Medicine Advanced Summer School (Online)<\/option><option value=\"Medical Course 04: Translational Medicine Advanced Winter School (in Person)\">Medical Course 04: Translational Medicine Advanced Winter School (in Person)<\/option><option value=\"Medical Course 05: Translational Medicine Basic Winter School (in Person)\">Medical Course 05: Translational Medicine Basic Winter School (in Person)<\/option><option value=\"Medical Course 06: Clinical Internship Program\">Medical Course 06: Clinical Internship Program<\/option><option value=\"Medical Course 07: Intensive Training Program\">Medical Course 07: Intensive Training Program<\/option><option value=\"Medical course 08: Post-graduate Internship Training Program\">Medical course 08: Post-graduate Internship Training Program<\/option><option value=\"Medical course 09: The contemporary role of genetic testing in rare disorders\">Medical course 09: The contemporary role of genetic testing in rare disorders<\/option><option value=\"Medical course 10: Train the Trainer Program\">Medical course 10: Train the Trainer Program<\/option><option value=\"Nursing Course 01: Emergency Nursing\">Nursing Course 01: Emergency Nursing<\/option><option value=\"Nursing Course 02: Healthcare In Hungary And Europe\">Nursing Course 02: Healthcare In Hungary And Europe<\/option><option value=\"Pharmaceutical Course 01: Applied macrocyclic chemistry\">Pharmaceutical Course 01: Applied macrocyclic chemistry<\/option><option value=\"Pharmaceutical Course 02: Assay methods in various pharmacopoeias\">Pharmaceutical Course 02: Assay methods in various pharmacopoeias<\/option><option value=\"Pharmaceutical Course 03: Basics of structure elucidation by NMR spectroscopy\">Pharmaceutical Course 03: Basics of structure elucidation by NMR spectroscopy<\/option><option value=\"Pharmaceutical Course 04: Applied biostatistics: nonlinear regression\">Pharmaceutical Course 04: Applied biostatistics: nonlinear regression<\/option><option value=\"Pharmaceutical Course 05: Cyclodextrins in the pharmaceutical industry\">Pharmaceutical Course 05: Cyclodextrins in the pharmaceutical industry<\/option><option value=\"Pharmaceutical Course 06: Physicochemical profiling of drug compounds\">Pharmaceutical Course 06: Physicochemical profiling of drug compounds<\/option><option value=\"Pharmaceutical Course 07: Drug research, Design And Development\">Pharmaceutical Course 07: Drug research, Design And Development<\/option><option value=\"Pharmaceutical Course 08: Essentials In Hospital Pharmacy Practice\">Pharmaceutical Course 08: Essentials In Hospital Pharmacy Practice<\/option><option value=\"Pharmaceutical Course 09: Pharmaceutical formulations-Drug Delivery Systems\">Pharmaceutical Course 09: Pharmaceutical formulations-Drug Delivery Systems<\/option><option value=\"Other\">Other<\/option><option value=\"Pharmaceutical Course 10: Pharmacovigilance in practice \u2013 Good Vigilance Practice\">Pharmaceutical Course 10: Pharmacovigilance in practice \u2013 Good Vigilance Practice<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label> Additional information<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"additional\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"additional\" \/><\/span> <\/label>\n<\/p>\n<p>Contact Details\n<\/p>\n<p><label> Country*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-country\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-country\" \/><\/span> <\/label>\n<\/p>\n<p><label> Postal Code*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"postal-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"postal-code\" \/><\/span> <\/label>\n<\/p>\n<p><label> City*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-city\" \/><\/span> <\/label>\n<\/p>\n<p><label> Address (street name, house number)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adress\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adress\" \/><\/span> <\/label>\n<\/p>\n<p><label> Phone*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-phone\" \/><\/span> <\/label>\n<\/p>\n<p>Invoicing Details\n<\/p>\n<p>To be filled in only if different from the details above.\n<\/p>\n<p><label> Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Tax number\/BIC code\/SWIFT code<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tax\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tax\" \/><\/span> <\/label>\n<\/p>\n<p><label> Country<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"country\" \/><\/span> <\/label>\n<\/p>\n<p><label> Postal code<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"postal\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"postal\" \/><\/span> <\/label>\n<\/p>\n<p><label> City<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span> <\/label>\n<\/p>\n<p><label> Address (street name, house number)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address\" \/><\/span> <\/label>\n<\/p>\n<p><label> Phone<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone\" \/><\/span> <\/label>\n<\/p>\n<p><label> Email<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-email-address\" \/><\/span> <\/label>\n<\/p>\n<p>I agree to receiving invoice in electronic form issued by Semmelweis University*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-560\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-560\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/span>\n<\/p>\n<p>Privacy settings\n<\/p>\n<p>I hereby consent to the publication of the photo and<br \/>\nvideo material made during the event. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-560\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-560\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/span>\n<\/p>\n<p>My name and contact information may be shared with the registered course participants *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-560\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-560\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/span>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-253\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"acceptance-253\" value=\"1\" aria-invalid=\"false\" \/><\/span><\/span><\/span><a href=\"https:\/\/semmelweis.hu\/english\/data-protection\/\" target=\"_blank\">Accept Terms and Conditions<\/a>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"SEND\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":102346,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-fullwidth.php","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-1688","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/semmelweis.hu\/short-courses\/wp-json\/wp\/v2\/pages\/1688","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/semmelweis.hu\/short-courses\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/semmelweis.hu\/short-courses\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/semmelweis.hu\/short-courses\/wp-json\/wp\/v2\/users\/102346"}],"replies":[{"embeddable":true,"href":"https:\/\/semmelweis.hu\/short-courses\/wp-json\/wp\/v2\/comments?post=1688"}],"version-history":[{"count":2,"href":"https:\/\/semmelweis.hu\/short-courses\/wp-json\/wp\/v2\/pages\/1688\/revisions"}],"predecessor-version":[{"id":1690,"href":"https:\/\/semmelweis.hu\/short-courses\/wp-json\/wp\/v2\/pages\/1688\/revisions\/1690"}],"wp:attachment":[{"href":"https:\/\/semmelweis.hu\/short-courses\/wp-json\/wp\/v2\/media?parent=1688"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/semmelweis.hu\/short-courses\/wp-json\/wp\/v2\/categories?post=1688"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/semmelweis.hu\/short-courses\/wp-json\/wp\/v2\/tags?post=1688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}