Course Application

 
Please complete the Application Form
Please complete all fields and questions
Course Information
Course Name: 8th Upper GI Training Course - Advanced Level
Course Date: 19 Dec 2020 - 20 Dec 2020
Course Fee:
Personal Details
Title:  
Given names: (as appeared on Passport / Identity Card)  
Last Name:  
Age:  
Mailing Address:  
Country:  
Email Address: (Confirmation email will be sent to this address)  
Contact Phone Number(s):
Office:
 
Affiliation:  
Nominated by:  
Recent Photo: (150x200px jpg or png file)  
Brief CV: (pdf or Word file)  
Questions
Year of experience: year
A brief description of your OGD experience.
How many cases of OGD have you performed in last 12 month?
How many cases of EMR have you performed in last 12 month?
Do you have any POEM Experience? Please describe.
How many Laparoscopic Upper GI Surgery you perform in the last 12 month?
A brief description of your gastrectomy experience.
(e.g. Diagnostic and for therapeutic)
About laparoscopic gastrectomy, any experience?
Overall experience in basic / medium level laparoscopic surgery?
No of cholecystectomy: case(s)
No of appendectomy: case(s)
Experience in UGI benign surgery
No of fundoplication: case(s)
No of myotomy: case(s)
No of GIST: case(s)
Experience in obesity surgery
A brief description of your colonoscopy experience.
(e.g. Diagnostic and for therapeutic)
About laparoscopic colectomy, any experience?
How many cases of laparoscopic colectomy have you performed in last 12 month?
What is your key drive in attending this course?




Remarks
  1. Registration Deadline: 31 August 2020.
  2. Applicant selection would be based on their clinical experience and the suitability to the course and the final decision would be made by the course director and the board members.
  3. Successful applicants would be notified by the APELS secretariat.
  
Please note that the above contact details will not be used for unsolicited e-mail or
be sold to third parties without the user's consent.