28th International Training Course for Full-endoscopic Operations of ...

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RegistrationPlease send your registration form to Medical Education, Bumrungrad Hospital Pclno later than November 30 th , 2012via fax number +66 (0) 2262 5022or e-mail: medical.education@bumrungrad.comYes, I will participate in the “28 th International Training Course for Full-endoscopicOperations of the Lumbar, Thoracic and Cervical Spine February 1 st -2 nd , 2013,Bangkok, Thailand.on only February 1 st , 2013; oron both February 1 st and 2 nd , 2013.Participant (please complete information below)First name:Surname:Title:Have you ever participated in any full-endoscopic operations of the lumbar, thoracic andcervical spine training course before?Yes, please specify date and place.NoHave you ever performed full-endoscopic operations of the lumbar,thoracic and/or cervical spine?Yes, please specify types and approximate number of cases.NoWould you and your spouse like to join welcome dinner at Pullman Hotel?Yes, please specify number.NoSpecial Dietary Needs:NoneSeafood AllergiesOther, please specifyVegetarianHalalHospital:Signature:Date:Street:City/Postcode:Country:Tel:Fax:Course fee: Thai ForeignerFor attending only lecture THB 2,000 USD 100on February 1 st , 2013For attending both lecture and THB 30,000 USD 1,200workshop on February 2 nd , 2013E-mail:Participants:There is a maximum of 30 participants for workshop on Saturday, February 2 nd , 2013.10 Symposium with Live-Operation And Cadaver-WorkshopDue to space limitation, only participants who receive confirmation from the OrganizationOffice will be registered for the training. The Organization Office will provide paymentinformation upon confirmation.
MapBumrungrad International Hospital33 Sukhumvit 3Klongtoey Nua, WattanaBangkok 10110, ThailandTel: +66 (0) 2667 1000Fax: +66 (0) 2667 2532
Page 3 and 4: Friday, February 1 st , 2013At Bumr
Page 5: Speakers / InstructorsMr. Dennis Br

28th International Training Course for Full-endoscopic Operations of ...

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