Under the patronage of:

ADVANCED COURSE

LAPAROSCOPIC NEONATAL SURGERY

9-10 May, 2019

Venue: Center of Biotechnologies – Cardarelli Hospital, Naples, Italy

MORE THAN 10 HOURS OF PRACTICE IN LIVE SURGERY ON RABBIT MODEL

DRY-LAB SESSIONS ON PELVIC TRAINERS AND THEORETICAL SESSIONS

PRE-REGISTRATION FORM

Please fill in and email to pedsurg.esposito@unina.it or fax to +39-0817463361

For further informations, please contact:

Prof. Ciro Esposito

Pediatric Surgery, “Federico II” University of Naples, Italy

Tel: + 39 081 7463378; Fax: + 39 081 7463361

E-mail: ciroespo@unina.it

First name:_______________________________________________

YOUR POSITION:

□ Specialist surgeon

□ Trainee

□ Other health professional

Surname: ________________________________________________

Department:______________________________________________

Institution:_______________________________________________

Address:_________________________________________________

City:____________________________________________________ □ ESPES/EUPSA/SIVI/SICP

member (deduct 10%) Country: _________________________________________________

Phone:___________________________________________________

Email:____________________________________________________

REGISTRATION FEES:

□ OPTION A - ADVANCED: includes participation in theoretical and live-surgery sessions

□ 1050/00 € Before February 24, 2019 □ 1300/00 € After February 24, 2019

□ OPTION B - BASIC: includes participation in theoretical sessions and pelvic trainer

□ 250/00 € Before February 24, 2019 □ 350/00 € After February 24, 2019