Application form Name * First name * Email * Country * - Select - City * Hospital *Add hospital Department * - Select -AnaesthesiologyAnesthesia & Critical CareAnesthesia & Intensive CareCardiologyCardiothoracic Intensive CareCardiovascular Intensive CareCritical Care MedicineGeneral Intensive CareHematologyInfectious DiseaseIntensive Care MedicineMedical Intensive CareNeonatal Intensive CareNephrologyNeuro Intensive CareNeurosurgical Intensive CareOncologyOtherPediatric Intensive CarePediatricsPulmonologySurgerySurgical Intensive CareTrauma Head of department * I am a Nurse or AHP * YesNo ESICM username *(if you don’t have an ESICM username yet please introduce N/A in this field) Validate Email