APPLY COURSE

Last name:

Given name:

Country:

Date of Birth:

Title:

Organization:

Affiliation:

Current Position:

Telephone:

Email:

  • 1. When did you graduate?

  • 2. What is your specialty?

  • 3. Years of practice in Gynaecology?

  • 4. Have you assisted any laparoscopic surgery in the past 6 months?

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  • 5. If so, how many cases did you assist every month?

  • 6. Have you done any laparoscopic surgery as a chief surgeon in the past 6 months?

    /

  • 7. If so, how many cases have you performed as a chief surgeon every month?

  • 8. What do you expect to learn from the laparoscopic surgery course? (can select more than one option)

SUBMIT
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