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Please copy this form to a Word or text file and mail it to me as an attachment to keesj@rdgg.nl . or fax it to +31.70.340.1173. After verification you will receive confirmation by fax. REGISTRATION FORM Identification data Center: Contact person: Center: Name: Address: street: Postal Code: Po box Postal code: Town: State: Country: Tel: Fax: e-mail: Name Medical director: Name Laboratory director: Web site: Approximate number of babies from blastocyst transfer so-far: Preferred ID: Preferred password: |
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Please send mail to keesj@rdgg.nl with questions or comments about this Web- Site Disclaimer:This information is not intended as a substitute for medical advice of physicians. The reader should regularly consult a physician in matters relating to his or her health and particularly with respect to any symptoms that may require diagnosis or medical attention. © Stichting Medische Voortplanting Voorburg. This material is copyright protected; improper or unauthorized use is an infringement of copyright-laws and is an actionable offense. Original information from this Web-site can only be used if the source is clearly cited. |