* Mandatory Field
FAS (Field to be published in the "Find a Surgeon" area)
Name *
Trade name *
Last name*
Birthdate*
Phone (Mobile)*
E-mail 1 *
Address
Zip code
City*
Country*
Social networks
Linkedin
Instagram
@
Payment details
Payment method*
Bank Transfer
Direct Debit
PayPal
Account holder*
Bank IBAN*
Incorrect IBAN number
Bank BIC
PayPal
Professional details
Institution (FAS)*
Address (FAS)*
ZIP Code (FAS)*
City (FAS)*
Country (FAS)*
Phone Number (FAS)*
Email (FAS)*
Website (FAS)
Surgical Specialty (FAS)*
Curriculum Vitae (FAS)
Amount (in dollars)
Max: 8MB
Other Details
Do you have experience in MIS Surgery?*
Yes
No
Have you attended a MIFAS by Grecmip Course?*
Yes
No
Do you agree to have your (FAS) details appear in the Find a Surgeon area of the website?*
Yes
No
Files
Photo
Invalid image
Data Protection Disclaimer
In accordance with the provisions of the General Regulation of Data Protection of the European Union, we inform you that the data introduced in this form will be treated exclusively for registration purposes and communications regarding educational activity within the society and is property solely of MIFAS by GRECMIP and will not be shared with other organizations. At any time you can exercise the rights of access, rectification, opposition, limitation, and, where appropriate, portability or cancellation by sending an email to contact@mifas.org
Terms and Conditions
By becoming an active member of MIFAS by GRECMIP I acknowledge the obligation to pay annually the fee of 90,00€ in order to benefit from the advantages to which members are entitled. The status "Active Member" will lapse at the end of each year and in order to remain an active member, the Annual Membership fee will have to be paid again at the beginning of the next year.
Powered by
© 2023 Berrly Data Tools, S.L.