REGISTRATION FORM
10th Riyadh International Bronchoesophagoscopy & Laser Course
14 - 15 February 2016 (5 - 6 Jumada I 1437)
Lecture: King Abdulaziz University Hospital - Riyadh
Hands-on: Animal Laboratory - King Saud University College of Medicine
* Required
Degree & Title:
Prof.
Dr.
Mr.
Ms.
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Name:
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Saudi Council ID No.
*
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Mobile No.
*
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Email Add:
*
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Hospital:
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City:
*
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Country:
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Position:
*
Consultant
Registrar
Resident
Intern
Student
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Are you coming in the Gala Dinner?
*
Brazilian Restaurant - Faisaliah Hotel
Yes
No
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Applied for:
SR2800 - Lecture, Hands-on & Gala Dinner
SR2700 - Lecture & Hands-on
SR500 - Lecture Only
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For more info please contact: Marivel (+966) 504826888 /
mdeguzman@ksu.edu.sa
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