AO ASIF Education Course-Davos Principles, Advanced, Complex Problems, Maxillofacial, and Spine Courses

December 12 - 17, 1999
Davos, Switzerland
Registration is limited. Do not consider yourself registed in course until official confirmation is received. Registration will not be accepted unless tuition fees are included with registration form.

Please complete this form in it's entirety to register.

You have the option to print this form, complete and return with payment to:

AO Course Secretariat
Re: Clavadelerstrasse
CH-7270 Davos-Platz
Phone: 41 81 414 27 20
Fax: 41 81 414 64 26

or you can complete this form and submit online using a credit card:

Course Name:

A check can be sent with the registration form. Please advise your bank to indicate your name on the payment check. You can also choose to make a bank transfer:

Bank: Credit Suisse 7270, Davos-Platz
Acc. No. 518.000-41-7/Bank code. 0187

Registration fee is $385.00. Fee includes all course and lab materials, continental breakfasts, lunch on first day and refreshments. Refunds (less $100.00 administration fee) will be issued if written cancellation notice is received by November 15, 1999.

Applications will not be accepted unless the Course tuition fees are included with the registration form.



Name:


Degree(s):


Attending
Resident

Social Security Number:

Number of years in practice:

Mailing address:

Home Phone:

Work Phone:

E-mail address:

Fax Number:

APPLICATIONS WILL NOT BE ACCEPTED UNLESS TUITION FEES ARE INCLUDED WITH THE REGISTRATION FORM.

If you need further assistance, please email courses@ao-asif.ch

Payment method:

Exp.Date: Card Number:
Signature (if mailing or faxing form):

Have you ever attended an AO ASIF Course? If so, which one?


Spine Course applicants please respond:
How many spine osteosynthesis have you performed?
0
Less than 60
More than 60
Are you an Orthopaedic surgeon or neurosurgeon with specialized practice?
Yes
No

Maxillofacial Course applicants indicate surgical specialty:
Oral and Maxillofacial
Otolaryngology
Plastic
Other

Do you have any special needs:

COURSE REQUESTED

Principles (Orthopaedic)
Advanced (Orthopaedic)
Complex Problems (choose one):
Choice 1: Systems of Trauma Care
Choice 2: The Reliability of Outcome Studies
Choice 3: Limb Salvage - How far can bionics go?
Maxillofacial Course
Spine Comprehensive Course
Spine Interactive Course
Spine Symposium
Banquet Ticket

HOTEL ACCOMMODATIONS

Single Room
Double Room
Arrival Date:

Departure Date:

Reservation Remarks:

Click here for Air Reservation Form

Please press this button
to submit your registration form:

Thank you.