AHA 2025 SCIENTIFIC SESSIONS

Amsterdam, Neitherlands

AHA 2025 Individual Registration Request

Complete the form to request registration for the 2025 sessions.

Title

First Name

Middle Name

Last Name

Date of Birth (DD-MM-YYYY)

Gender

Contact Phone Number

Primary Classification

Customer Segment

Speciality

Badge First Name

Job Title

Company / Instituition / Hospital

Address

Post Code

City

State

Country

Nationality

Age Range

Registration Category

Registration Type

Membership Number

NPI Number National Provider Identifier Standard (optional)

Do you wish to add the On Demand access

Is this your First Session

Primary Council

Emergency contact name*

Emergency contact phone number*

Are you accredited to prescribe medicine?

I agree to the Terms & Conditions