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bariatric and metabolic surgery fellowships 2012 - The Association ...

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NameCurrent AppointmentMetabolic Fellowship<strong>2012</strong>GMC NumberNTNHome addressCCT DatePart III exam dateHome TelephoneWork addressWork TelephoneMobile numberEmail addressWhich fellowship locationsare you applying for(rate 1 to6, one being highestpreference)North Tyneside Sunderl<strong>and</strong> LutonImperial UCH TauntonHigher DegreeHave you applied before?Have you been interviewedbefore?Yes/NoYes/NoYes/NoType:Eg: MS,MD,PhDOperative Experience TO DATE PRIMARY SURGEON ASSISTANTGastric B<strong>and</strong>ingGastric BypassSleeve GastrectomyBariatric Revisional SurgeryOther Bariatric proceduresLaparoscopic CholecystectomyLaparoscopic NissenLaparoscopic Other, Including Hernias.STC Chairman Contact detailsCurrent Trainer RefereeCONSULTANT APPLICANTChief Executive <strong>and</strong>Medical Director Contact details

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