Friday, May 9, 2014

The 6th International Workshop for Vaginal Fistula Repair and Female Urethral Reconstruction

https://www.facebook.com/events/437220939746714/
The 6th International Workshop for Vaginal Fistula Repair and Female Urethral Reconstruction

Application Form 2014
Aswan, Egypt December 18th – 20th, 2014 



we must emphasize this course might not be suitable for those with no previous surgical experience. 
Please confirm that you understand this by ticking the box 

what are your aims in attending this course? ……………………………………………………

……………………………………………………………………………………………………

Title ……………. First Name ………………………………………………. 
(in BLOCK CAPITALS please)

Surname ……………………………………….……………………………

Position/Specialty ……………………….…………..…………………..…..

Hospital ……………………………………………………………………….

Full Mailing Address (for correspondence) ………………………………………………….…

…………………………………………………………………………………...……………….

………………………………………………………………………………….……………….

Telephone (with code) ………………………………………………………....

Email : ……………………………….………………..

Special Interest Urology / Obs & Gynae / Other (please specify) …………………….…………

I enclose the total course fee of $ 1500 

Please send an invoice for the course fees to: ……………………………………………………..………

Please send application form to: Prof. Sherif Mourad, 12, Botrous Ghaly St. 7th Floor, Roxy, Heliopolis, Cairo, Egypt
Tel: + 2010 5355353; Fax: + 20 (2) 2455 3443; Email : msmourad@tedata.net.eg

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