Registration form

Congress registration

Welcome to the registration for the prestigious exam to become Fellow of the European Board of Surgery in MIS (Minimally Invasive Surgery). Successful EBSQ MIS Eligibility and Examination candidates are awarded the title "Fellow of the European Board of Surgery/MIS – F.E.B.S./MIS"

Personal data

Title

First name

Family name

E-mail address

E-mail address 2

Nationality

Date of birth

Country of birth

Gender

Citizenship

Correspondence address

Country

Mobile number

Country where surgical residency was completed

Are you an EAES member

Yes
No

EAES membership number

Do you require a visa support letter?

Yes
No

Name(s) for visa support letter exactly as it appears on passport

Passport number

Hospital / institution details

Name Hospital / organisation

Department

Address

Country

Is your invoice address different than above Hospital / Institution address?

Yes
No

Only fill out below invoice address when different than above Hospital/institution address

Please do NOT use ALL capital letters when filling in your personal details.

Company/Institution

Street

Postcode

City

Country

Applicable for travel agents

VAT number

Contact name

E-mail contact person

Required documents to upload

Please note: if you have more than 1 document, save them as 1 complete file for upload (only submit .pdf, .jpg, Word, jpeg, .tiff, .png files). Maximum is 10mb upload

How to fill out the log-book: instructions catalogue of procedures & operations.
First download the eligibility documents by clicking on the blue links.
– log-book with endoscopy click here
– log-book without endoscopy click here

Upload here the Logbook EBSQ/MIS that applies to you

Declaration by trainers needs to be signed by 2 independent experts from 2 different institutions. Download the document to be signed by 2 trainers and countersign by your hospital executive/head of department click here

Declaration

Letters of recommendation (not compulsory)

A national CCST (Certificate of Completion of Specialist Training)

Basic laparoscopy courses certificates

Advanced laparoscopy courses certificates

Fellowship in MIS certificates (if applicable - not compulsory)

Faculty/trainer at recognized MIS course/center certificates (if applicable - not compulsory)

Payment, cancellation and refund

Any application may only be considered for eligibility after receiving a non-refundable eligibility fee of €200. Eligible candidates will also be requested to cover Examination fee of €1000. Notification of cancellation must be sent by e-mail to the Exam Secretariat. Cancellation with refund of the Examination fee of Euro 1000 will be accepted until 20th May 2023. No refund will be made for cancellations after 20th May 2023.

I have read the cancellation and refunds policy

By submitting your registration you agree that the photographs taken during the congress, in which you may appear, may be used for publication by EAES. This is in accordance with the EAES GDPR policy

I confirm and agree to the EAES GDPR policy

Send me the administration fee invoice

Registration form

Congress registration

Personal data

Hospital / institution details

Only fill out below invoice address when different than above Hospital/institution address

Applicable for travel agents

Required documents to upload

Please note: if you have more than 1 document, save them as 1 complete file for upload (only submit .pdf, .jpg, Word, jpeg, .tiff, .png files). Maximum is 10mb upload

Payment, cancellation and refund

After you have submitted your registration, please e-mail any changes or additions to Muriel.Breemans@eaes.eu.

DO NOT REGISTER AGAIN