Application

MMAS Course

Mastery in Minimal Access Surgery skill course

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Organizer & contact details

Organizer name*

Primary institution*

Email*

Phone number*

AMASI membership number

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Event details

Preferred date*

Alternate date

Zone*

Venue

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Venue type

Venue name

Address

City

State

Postal code

Country

Auditorium facilities

Hall AHall BAV equipmentEndotrainers

Supporting photos

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Committee member photo

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Institution photo

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Agreements

I agree to the AMASI terms and conditions for hosting this event.I certify that all information provided in this application is accurate.I confirm I have the authority to submit this application on behalf of my institution.