EANS Examination in Neurosurgery 14th February 2009 1600 ...



European Board Examination in Neurological Surgery – Part I

31 August 2019, 15:00 – 18:45

Brno, Czech Republic

Please note that the deadline for submission of this form is 15 July 2019. Please before applying for the exam be sure that you could have the visa to enter the country for the exam on time.

In case the number of application exceeds the exam capacity, the applications can be closed prior to the above date.

DO NOT COMPLETE THIS FORM OR PAY THE EXAM FEE IF YOU ARE ON THE EANS TRAINING COURSES!

Surname: First Name(s): Nationality:

Date of birth: Place of birth: Start of Neurosurgical training (year/month):

Department: Hospital:

Your current position (resident/registrar or qualified NS/consultant etc.):

Hospital address:

Home address

E-mail (for all correspondence incl. results and certificate):

Phone number work: Cell phone number:

Signature of participant:

Signature of Head of Department:

Please send this form electronically to Visi Navarro – visi.navarro@

Please include scanned copies of:

• Your birth certificate/passport

• Your Medical Degree

• Your curriculum vitae stating your medical education, previous and present position as a trainee/neurosurgeon and signed by your chief.

The payment of the examination fee should be made to the account below no later than two weeks after the application was approved by the EANS office. Please state your name and that it is for the Brno examination 2019 and don’t forget to cover all bank charges yourself.

Bank: KBC, Havenlaan 2, B-1080, Brussels, Belgium

IBAN: BE67 7350 4558 0587

BIC: KREDBEBB

Account name: Training Courses

Beneficiary address: EANS wzv, Brandstraat 36, 9830 Sint-Martens-Latem, Belgium

Fees:

Neurosurgeons in training program in EANS member country 200 Euros

Neurosurgeons in training program in non-EANS member country 300 Euros

Neurosurgeons after completing the training program 300 Euros

Please kindly note that it can take up to 2 weeks to process applications for the exam.

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