Registration

1 Personal Details

2 Educational Details

3 Employment Details

Last name(s)*
Last name(s) on the diploma
Name(s)*
Date of birth*
Croatian Personal Identification Number*
Address
City
Zip code
Country
Citizenship
E-mail address*
Mobile phone
Phone
Fax

Year of graduation*
Specialisation
Achieved academic title
- Doctor Primarius
- PhD
- Professor
- Academician (FCA)
- Other

Name of the institution
Address of the Institution
Phone
Additional Information

IBAN: HR8423400091110024619
University of Zagreb School of Medicine
Šalata 3, 10000 Zagreb, Croatia
Payment model: HR00
Reference number: 1944
Payment description: AMAMUZ Membership
Bank SWIFT/BIC Number: PBZGHR2X
Bank name and address: Privredna banka Zagreb d.d., Radnička cesta 50, 10000 Zagreb