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World Robotic General Surgery Symposium - Hospimed CZ

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<strong>World</strong> <strong>Robotic</strong> <strong>General</strong> <strong>Surgery</strong> <strong>Symposium</strong><br />

June 27-29, 2011 Loews Miami Beach Hotel, Miami Beach, Florida<br />

Course Fee Includes all course materials, continental breakfasts and lunches.<br />

Ending April 30 Starting May 1 Other offers<br />

2.5 Day <strong>General</strong> <strong>Surgery</strong> Session - Physicians (June 27-29) $749/person $799/person<br />

2.5 Day <strong>General</strong> <strong>Surgery</strong> Session - Residents and Fellows (June 27-29) $599/person $649/person<br />

1 Day Colorectal Session - Physicians (June 28) $449/person $499/person<br />

1 Day Colorectal Session - Residents and Fellows (June 28) $379/person $419/person<br />

1 Day Allied Health (June 29) $299/person $349/person<br />

1 Day Executives (June 27) $299/person $349/person<br />

3 Day Allied Health (June 27-29) Circle one session per day to attend: $499/person $549/person<br />

Monday: URO / TRANSORAL / GEN SURG<br />

Tuesday: URO / GEN SURG / TRANSORAL<br />

3 Day Executives (June 27-29) Circle one session per day to attend: $499/person $549/person<br />

Tuesday: URO / GEN SURG / TRANSORAL<br />

Wednesday: CARDIOTHORACIC / PEDS / GEN SURG / URO<br />

Total Attendees______________ Total Fees________________<br />

Registration Form<br />

Please print. All fields required.<br />

Society of <strong>Robotic</strong><br />

<strong>Surgery</strong> Premier<br />

Membership: $200<br />

- Includes online Journal<br />

of <strong>Robotic</strong> <strong>Surgery</strong><br />

subscription<br />

- For more information<br />

please visit www.<br />

S<strong>Robotic</strong>s.org<br />

Journal of <strong>Robotic</strong><br />

<strong>Surgery</strong> 1 Year<br />

Subscription: $50<br />

Name __________________________________________________________Title ____________________________________________________<br />

(As it will appear on certificate)<br />

Address ________________________________________________________________________________________________________________<br />

City________________________________ State___________________ Country___________________________ Zip______________________<br />

Office Telephone _____________________________ Mobile Telephone____________________________ Fax __________________________<br />

E-mail________________________________________________________ Company/Organization_______________________________________<br />

Check: Make checks payable to Florida Hospital<br />

Visa/MC/Discover/American Express (Circle one)<br />

Card Number ______________________________________________ Exp. Date___________________<br />

Name as it Appears on Credit Card ____________________________________________________________________________________<br />

Authorized Signature ________________________________________________________________________________________________<br />

Please check here if you would like to receive additional information regarding DaVinci® <strong>Robotic</strong>s Training<br />

Mail or fax to:<br />

Pennyjo Griggs<br />

Florida Hospital Celebration Health<br />

410 Celebration Place, Suite 401<br />

Celebration, FL 34747<br />

Phone: (407) 303-4587<br />

Fax: (407) 303-4189<br />

For online registration or inquiries:<br />

Please visit our Web site at<br />

www.Global<strong>Robotic</strong>sInstitute.com<br />

Or contact Pennyjo Griggs at:<br />

Pennyjo.griggs@FLHosp.org<br />

(407) 303-4587<br />

www.Global<strong>Robotic</strong>sInstitute.com/WRS

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