Your name*
Your email*
Workplace*
Position*
Address*
Phone number*
Years of experience* Please indicate how many years of experience you have working in the field of dystonia and/or spasticity. (To complete the program as a physician, you should already be treating patients with botulinum toxin or be prepared to start doing so when the program begins.)
Multidisciplinary team* Are you working in a multidisciplinary team that includes both physicians and therapists? If you are applying together as a team, please let us know.
Motivation* Please describe your motivation for applying to the program. (You can write as long text as you want in this field below, beyond the width.)
Please leave this field empty.