Registration form - 1st Hands-on Course in Single Site Laparoscopy Pediatric Surgery
Please fill in all information to be registered and to reserve one of the 24 limited places.
Once the document is sent, an e-mail will be return to you to confirm that the registration process was successful and to receive the bank data to do the payment by bank transfer or VISA card.
You can benefit with EUPSA and ESPES discounts.
If you have any consultation about payment, accommodation or registration contact to ssls@viajesaustral.com
Name *
Your answer
Last name *
Your answer
Working Address
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Address
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City
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Postcode
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Country
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E-mail *
Your answer
Confirm your e-mail *
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Phone *
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EPES member? *
10% discount
EUPSA member? *
10 % discount
What laparoscopic surgical level do you have? *
Standard laparoscopy
Required
What Single Site laparoscopic surgical level do you have? *
Single Site laparoscopy
Required
Registration
After the 1st of August
TOTAL amount *
Please introduce the final amount
Your answer
Payment Options *
Choose one of the two options
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