Fundamentals of Research & Career Development Course & Minimally Invasive Surgery Workshop

Abuja, July 13-15, 2009

REGISTRATION FORM

REGISTRATION FEES:

PROGRAM                                                           Early Registration                              Late Registration

                                                                                Before April 20, 2009                        Until May 30, 2009

Research & Career                                             

Development Course ONLY                             N32,000 or $200.00                            N40,000 or $250.00

Minimally Invasive Surgery             

Workshop ONLY                                                N32,000 or $200.00                            N40,000 or $250.00

Both Programs                                                     N40,000 or $250.00                            N48,000 or $300.00

West African members of the AAS will receive a $50(N8,000) reimbursement upon confirmation of membership

On-site registration will be allowed only in exceptional circumstances if space permits

REGISTRATION INFORMATION:

  Check box if you are an AAS member

(Double-click the box, choose “checked”, and then OK)

Which program do you wish to attend?

  Fundamentals of Research & Career Development Course ONLY     Minimally Invasive Surgery Workshop ONLY

  Both programs                                                                                                             

What is your level of training?

 Resident                            Fellow               Consultant                       Other

Please complete following information:

(Begin typing into the text field)

Name:                                                                                             Specialty:      

Institution:                                                                                     City:                                State/Region:                               

Country:                                                                                                         Phone:                             E-Mail:                       

PAYMENT:

Payment in full must accompany registration. Please follow one of the following procedures:

A)      Pay appropriate fee at any branch of the Equatorial Trust Bank (ETB) Acct name: JSP/AAS Seminar

a.       For payment in Naira use account # 0270014835218

b.       For payment in US Dollar use account # 0276014835224

Send a scanned copy of the teller advisory AND completed registration form by email to: africancourse@gmail.com

B)      Payment may also be made by bank draft in the name of “JSP/AAS Seminar” and sent, with completed registration form, to JSP Communications (Attn: Mrs. Aderonke Adebule) 61 Ogundana Street, Off Allen Avenue/Hilton Drive, Ikeja, Lagos, Nigeria

Notifications of cancellation must be submitted in writing. Cancellations received before May 30, 2009 will be refunded less a US $50 (N8,000) administrative fee. Cancellations will be honored but fee not refunded after May 30, 2009.

ADDITIONAL INFORMATION

For additional information please contact Mrs. Aderonke Adebule (0802-3182908 or 01-8926221) or E-mail: africancourse@gmail.com. You may also contact Course Directors: Evan Nadler (evan.nadler@nyumc.org) or Ben Nwomeh (nwomeh.1@osu.edu