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Institution* (required)

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Department

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Degrees

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Title/Honorific* (required)

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Address 1* (required)

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Address 2

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City* (required)

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State/Province

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Zip* (required)

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Country* (required)

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Day Phone (with a country code)* (required)

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Mobile phone (with a country code)

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Email* (required)

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Number of DBS-procedures per year at your department

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Total number of DBS procedures in which you have participated

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Total number of DBS procedures which you have yourself performed

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How many DBS procedures do you expect to perform yourself next year

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Indications for DBS at your department (e.g., Parkinson’s disease; dystonia; tremor; OCD; depression; Tourette’s syndrome; epilepsy; pain)

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Targets used for DBS in movement disorders at your department (e.g., STN; Gpi; Vim; Zi/raprl)

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Stereotactic frame used at your department

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