form


Surname:

First name:

Address:


Country:

Job title:
Specialisation:
ENT
Neurosurgeon
Hospital affiliation:

Work address:


Telephone number:

Email:

What is your aim from this course?

We will confirm your registration by email and post once we have received the fees (1200 euros) to the course account.

ABN-AMRO Bank Amsterdam,
PO Box 12771,
1100 AT Amsterdam
bank account number 45 10 37 596
name of the account  ‘St. Aero’
IBANnr. NL52ABNA0451037596
BICnr.  ABNANL2A

 

*Payment by direct credit transfer in Euro, ‘in full’ to ensure no commission fees or bank
charges are deducted.