31st INTERNATIONAL COURSE IN ADVANCED RHINOPLASTY TECHNIQUES October 14, 15 and 16

31st INTERNATIONAL COURSE in

ADVANCED RHINOPLASTY TECHNIQUES

OCTOBER 19-20-21 | 2022

University Medical Center, Utrecht - Netherlands

Application Form for REGISTRATION 2022

SURNAME:*

FIRST NAME:*

E-MAIL:*

example@example.com

TELEPHONE:*

ADRES (private):*

CITY*

ZIP CODE:*

COUNTRY:*

PROFESSION:*

INSTITUTE*

POSITION:*

SpecialistResident

GENDER:*

MaleFemale

MEMBER:*

EAFPSERSNone

COVID-19

In response to the developments regarding Covid-19, we will closely follow the directives issued by the responsible authorities. At the current time, we remain optimistic that the Advanced Rhinoplasty Course can be held as scheduled in October 19-21, 2021.

In the unfavorable scenario that the Course has to be cancelled or you are not able to join us, you will be automatically scheduled for the 2023 Course, or later if you prefer.

The 2023 Course is scheduled on October 25, 26 and 27. If you have any questions, please let us know by sending us an email.

10 % Reduction TUITION FEE for EAFPS and/or ERS members (not for Dinner and Symposium)

Course with dissection (fully booked)

-

Course without dissection

-

Workshop

-

Symposium

-

Dinner

1750 € for Specialists

1350 € for Residents

1100 € for Specialists

800 € for Residents

650 € for Specialists

500 € for Residents

FREE for participiants Course and/or Workshop

200 € for non-participiants

90 € per person

Course with dissection Oct. 19, 20, 21

-

Course without dissection Oct. 19, 20, 21

-

Workshop Oct. 21, afternoon (fully booked)

-

Symposium, Oct. 21, morning

-

Dinner, Oct. 20, evening

I

Course (Course WITH dissection is fully booked)*

Without dissectionNo, not attending

II

Workshop (fully booked)*

No, not attending

III

Symposium (included for participants Course and/or Workshop)*

Yes, I only attend the symposiumIncluded, I participate Course and/or Workshop

IV

Dinner (October 20 - evening)*

Yes, one personYes, two personsNo, not attending

Calculation

I + II + III + IV*

EUR

PAYMENT:

By direct credit transfer in Euro "in full" to ensure no commissions fees or bank charges are deducted.

Bank accout IBAN: NL43 INGB0007485706

BIC: INGBNL2A

On behalf of: Advanced Rhinoplasty - please mention your name + Rhinoplasty Course 2022

Cancellation costs 50 % before September 22nd 2022 and 100 % after.