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MEMBERSHIP APPLICATION

Personal data




Billing address


Contact details


Current hospital appointment:



Education




Membership of National and or other Scientific Societies





Training




For residents only


For physicians only

Board certification



Current Endoscopic Experience

Procedures


Academic appointments

(begin with current)



Past Hospital appointments




I authorise the European Association for Endoscopi Surgery to obtain information from any source regarding this application and my qualifications for membership.

I hereby certify that the above information is correct and is given in good faith.

I declare that I have read and agree to the EAES GDPR Policy