BSGE ANNUAL SCIENTIFIC MEETING 2016
‘Training in Endoscopic Surgery – From Shifting Sands to Firm Foundations’
Bedruthan Hotel, Trenance, Mawgan Porth, Cornwall, TR8 4BU
Registration Form
Please complete clearly and in BLOCK CAPITALS
Please send in your registration form with payment before 15th April to qualify for early registration fee for ASM.
Title: ...... First name: ...... Surname: ......
Specialty: ...... Grade: ......
Work Address: ......
...... Post Code: ......
Mobile no: ...... *Email: ......
Dietary requirements or any special access needs: ......
*NB: It is important that you provide an email address so that notification can be sent to you when final details of the conference are available on the website.
Pre-congress courses
To be held at Royal Cornwall Hospital
On Monday, 16 May
Please select which Pre-Congress course you would like to attend.Pre-congress Courses / Until 9/5/2016 / Onsite fee from 10/5/2016
Live Laparoscopic surgery Training Masterclass
Limited to 100 delegates / £75 / q / £100 / q
Ambulatory Hysteroscopy Training
Limited to 20 delegates / £75 / q / £100 / q
HOT session - Hands on dry lab Training + Testing
Limited to 20 delegates / £75 / q / £100 / q
BSGE Member
before 15/4/16 / BSGE Member
16/4/2016 until 9/5/2016 / Non Member
before 15/4/16 / Non Member
16/4/2016 until 9/5/2016
Senior / £250 / q / £300 / q / £300 / q / £350 / q
Trainee / £200 / q / £250 / q / £250 / q / £300 / q
Nurse/ Medical student / £150 / q / £180 / q / £200 / q / £230 / q
Please select
I would like to attend the Welcome reception and Barbeque on 16th May at Bedruthan Hotel / Yes / No
Please book me on - Live Laparoscopic surgery Training / Yes / No
Please book me on - Hysteroscopy Training session / Yes / No
Please book me on - The HOT session Training / Yes / No
Please book me on transport to Bedruthan Hotel after my Pre-congress training / Yes / No
I will be attending the BSGE Gala Dinner at Eden Project on 17th May (£30 supplement)* / Yes / No
*Please note, BSGE Annual Gala dinner is limited to 250 delegates only.
Use the table below to calculate your total
Cost £Pre-congress training course
Registration fee (see table above)
Attending Barbecue – complimentary if booked / 0
BSGE Gala Dinner at the Eden Project / 30
Total
Day delegate rate is 70% of full delegate rate.
Onsite delegate rates will apply from 10th May 2016
Please visit BSGE website for full details
I would like to attend and I enclose a cheque for £......
Please enclose your cheque made payable to 'BSGE' with this form and return to:
Atia Khan, BSGE Secretariat, 27 Sussex Place, London, NW1 4RG by 9th May 2016.
For online bank transfer, please email