DELEGATE REGISTRATION FORM
TITLE
*
:
Prof.
Assoc.Prof.
Dr.
MSc.
BSc.
Mr.
Ms.
Others
FULL NAME
*
:
ORGANIZATION
*
:
POSITION / DEPARTMENT
*
:
ADDRESS
*
:
Email
*
:
PHONE NUMBER
*
:
Gender
*
:
Male
Female
DATE OF BIRTH
*
:
SHORTCV
*
:
SHORTCV
CHOOSE FILE
PASSPORT
*
:
PASSPORT
CHOOSE FILE
PRE-CONFERENCE WORKSHOP
*
:
Yes
No
SPECIALIZED IN
*
:
GI Surgery
Urology
Orthopedic Surgery
Others. Please Specify:
YEARS OF EXPERIENCE
*
:
WORKSHOP REGISTRATION
*
:
Percutaneous Nephrolithotomy
Inguinal Hernia Surgery
Knee Arthroscopy
GALA DINNER REGISTRATION
*
:
Yes
No
PAYMENT METHOD
*
:
Pay in advance
Pay onsite
FORM OF PAYMENT
*
:
Wire transfer
Account name: Hội Ngoại khoa và Phẫu thuật nội soi Việt Nam
Account number: 113001060002156
Bank: Ngân hàng TMCP Bắc Á - PGD Hàng Bông - CN Hà Nội
Transfer content: NAME + ORGANIZATION + PAID REGISTRATION FEE VASEL 2025
Cash
VASEL Office - Training and Direction of Heathcare Activity Center
1F, Building B1, Viet Duc University Hospital, No. 40 Trang Thi Street, Hoan Kiem District, Hanoi, Vietnam
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