Registration Form

for all inquires: (+603) 4023 4700 (+603) 4025 4700

Fields marked (*) are compulsory

A: PERSONAL PARTICULARS
Salutation:* Prof A/Prof Dr Mr Mrs Ms		Gender: * Male Female
Full Name: *		Date of Birth: *
Correspondence Address: *
State: *	Country: *	Postal Code: *
Contact Number: *	Mobile Number: (Optional)	Facsimile Number:
Email Address: *	Institution: *	Specialty: *
Are you the APOA/APSS Existing Member?: * Yes No
B: REGISTRATION FEES *
Category		Amount Payable
INTERNATIONAL SURGEON
APSS Member		USD 300
Non-APSS Member		USD 400
INTERNATIONAL SURGEON FROM REDUCED RATE COUNTRIES
APSS Member		USD 200
Non-APSS Member		USD 300
TOTAL (USD)
By registering to the APSS Lahore Operative Spine Course, I agree that I will be personally responsible for my security and safety for travelling to and participating in this course. I am aware of this personal risk assumption and agree to waive any claims for injuries or damage, and release APSS from any liability.

Please enter the text as below *

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