Training Course in Laparoscopic Hernia Surgery

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*Space is limited and will be filled strictly on first come first serve basis.

*Correspondence is preferable by e-mail, so write your e mail address clearly.

Note: Please choose the Online option if you would like to complete the forms online. If you do this, you may complete the forms online and you can pay by a demand draft drawn in favour of "MINIMALLY INVASIVE SURGERY TRAINING CENTRE"at the address above.

Please make sure to put the demand draft number and date on the online form. You have the option to download forms in PDF format if you wish to print and mail us the form.

Course*

Course Date Preferences

1st Preference*:
2nd Preference*:
3rd Preference:
4th Preference:

Personal Details

Name*:
Qualification*:
Designation*:
Insitution*:
Address*:
Phone*:
Mobile*:
*Email:**
Fax:

Payment Details

*Amount Rs.:**
*Draft No.:**
Dated*:
*Drawn on:**

Course Fee


Indian Delegates- Rs. 8000/- only
Indian Hernia Society Members Rs 6500/- only
SELSI members Rs. 6500/- only
Postgraduates Rs. 4500/- only
(Certificate from Head of Department is essential) Please bring two Pasport Size photograph

FOR HERNIA / COLORECTAL / SUTURING COURSE ONLY

How many Laparoscopic procedure do you do per month

Which laparoscopic procedures you are doing at present?
Which laparoscopic procedures you are doing at present? Laparoscopic cholecystectomy Laparoscopic hernia Diagnostic Laparoscopy Laparoscopic Heptobiliary Laparoscopic Gynae Procedures Laparoscopic colorectal Laparoscopic upper G.I.
Where did you get your basic laparoscopic training?

How many years since you are doing laparoscopic surgery?

You work in which type of set up?

Name of the hospital

All fields marked with * are compulsory.

Payment : All Payments by Demand Draft/Local cheque only in favour of "MINIMALLY INVASIVE SURGERY TRAINING CENTRE" payable at New Delhi (India)
Please include your email address for confirming the course dates.

Registration

AIIMS / Mistc