Application form for EAES endorsement basic & advanced courses in endoscopic surgery

Course / event details

Select type of endorsement

Basic & advanced courses / webinar(s)
Industry sponsored webinar(s)
Event: congress /Meeting

Hospital / Institution / Industry

Course / event title:

Starting date

End date

Title director

First name director

Last name director

Location / venue

Address

Postcode

City

Country

Course type

Theoretical

Practical

Course language

Course contact details

Title

First name

Last name

Phone

E-mail: for information & registration

E-mail address cc

Course / event website

Upload the required documents

Only submit: pdf, jpg, word, jpeg, tiff, png format files
If you have more than 1 document, save them as 1 complete file for upload

Faculty list: List all the faculty announced in the programme. Please upload a list to include: title (Dr. Prof etc), first name, last name, indicate if EAES member-Yes or No

Short CV director (s) including a list of publications

Program: to include a short course description: Target group, minimum suggested skills, number of participants, objectives, resources, accreditation, hands-on activity, registration fees etc...

Budget overview

Official animal right certificate, local hygiene approval

I authorise the European Association for Endoscopic Surgery to obtain information from any source regarding this application.
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

Click here to agree and confirm