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[{"$nulls":3},"Send to:",null,null,"mice-trv@nittsu.co.jp"]
[]
["Complex Cardiovascular Therapeutics 2016                                           Group Pre-Registration Form　－1"]
[]
["■Contact Information"]
["Name"]
["Affiliation"]
["Department    /Division"]
["E-MAIL"]
[]
["■Payment -Credit card Information"]
[]
[null,null,"Visa",null,null,"Master",{"$nulls":3},"JCB",null,null,"Diners",null,null,"Amex"]
["Credit Card  Number"]
["Expiration",{"$nulls":4},"／",20,{"$nulls":3},"( month / year)"]
["Cardholder's Name"]
["Contact TEL No."]
["Contact E-mail address"]
[]
[]
[null,"Go to next page - Participants Infomation"]
[]
[]
["Name card pick-up vouchers will be sent after the confirmation of payment.Name cards of the registrants will be provided to the representative at the below site. Please pick up all name cards at once.\nWednesday, October 19, 2016    16:00-18:00   at the registration desk, 1F, Kobe International Exhibition Hall 2"]
[]
[]
["Cancellation after submitting application form, even a part of submission, will not be accepted.\nChanging a registrant's name will be charged 5,400JPY(incl. tax) per each registrant. (By September 30, 2016)\nAny changes after October 1, 2016 will not be accepted.\n\n\n"]
[]
[]
[null,"Contact：",null,null,"CCT2016 Registration Desk"]
[{"$nulls":4},"TEL：06-6201-1962",{"$nulls":4},"E-MAIL：mice-trv@nittsu.co.jp"]

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["Complex Cardiovascular Therapeutics 2016 Pre-Registration Form　－2"]
["Group Name",null,{"$f":"'Contact Infomation'!C7:Q7","v":0},{"$nulls":10},"0-99"]
[{"$nulls":12},"Cardiologist (Catheter Intervention), ","100-299"]
["■Participants Information -Please input all participants information including representatives. ※= required item",{"$nulls":11},"Cardiologist (Arrhythmia, Cardiologist (General)","300-499"]
["NO","※First Name(s)","※Family Name","Middle Name","※Ticket Category","※Nationality","※Occupation","※Affiliation","Department/Division","E-mail Address","Number of Cases Performed as Main Operator in 2015 (for interventional cardiologists only)",null,"Cardiac Surgeon","500-999"]
[1,{"$nulls":11},"Radiologist","over 1000"]
[2,{"$nulls":11},"Medical Doctor (other professional)"]
[3,{"$nulls":11},"Nurse"]
[4,{"$nulls":11},"Clinical Technician"]
[5,{"$nulls":11},"Radiological Technician"]
[6,{"$nulls":11},"Cliinical Laboratory Technologist"]
[7,{"$nulls":11},"Pharmacist"]
[8,{"$nulls":11},"Industrial Professional"]
[9,{"$nulls":11},"Other"]
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
[30]