3rd Course of Peripheral Nerve Surgery of the World Federation of Neurosurgical Societies

24th – 26th September 2018

Venue: Bad Soden a. Ts & Giessen GERMANY

(Near to Frankfurt International Airport)

Theory & Live-Surgery: Department of Neurosurgery Krankenhaus Bad Soden Kronbergerstrasse 36 D-65812 Bad Soden am Taunus	Cadaveric Dissection: Institute of Anatomy Justus Liebig University Aulweg 123 D-35392 Giessen
(Bus Group Transport Bad Soden – Giessen – Bad Soden will be provided)

REGISTRATION FORM

Title, Name	First name Middle Initials Family Name
Institution / Affiliation	Your department Name of institution Country
Address	Street and house number
City / Province	City / Province Postal Code
Country*	Country	*Country classification under World bank list of economies 2017
please consult the attached world bank list of economies 2017
Phone	+49 69 123 45 60
Fax	+49 69 123 45 67
Email	your email address
URL	your website, if available
REGISTRATION FEES
High-income and upper-middle income Countries
Course with Cadaveric Dissection	€ 1000,00
Only Course	€ 500,00
Low-income and Lower-middle income Countries
Course with Cadaveric Dissection	€ 600,00
Only Course	€ 400,00
Bank Details:	IBAN: DE09 300 6060 1000 527 05 88 BIC: DAAEDEDDXXX Address: ApoBank, Manizer Landstrasse 275, 60326 Frankfurt am Main Wire Transfer References: Your Name - WFNS-PNS-2018 Chose one: Chose one:
Date:	22.07.2018	Signature:	Type your initials here
Submission deadline: July 22nd, 2018
Checklist:	wire-transfer registration fees as mentioned above & download a copy of transfer confirmation fill-in the registration form and save it as “YOUR SURNAME- WFNS-PNS-Registration-2018.doc” Send both registration form and the bank transfer confirmation to:
Email: kkrishnan@kliniken-mtk.de or Fax: +49 69 269 13 021