Registration form for Hands on workshop EUS and Interventional Endoscopy
Section 1: Personal Information
Name
Date of Birth
Gender
Male
Female
Other
Address for Correspondence with City
Mobile No.
Email ID
Qualification
Section 2: Practice Setting
Practicing in
Public Hospital/ Solo
Private Hospital/Clinic
Hospital Attached
Section 3: Experience in Endoscopy
Your Experience
-- Select --
Doing for >5 years
Doing for 1–5 years
Doing for <1 year
Just started since a few months
Not started yet, equipment existing
Not started yet, planning to purchase
Section 4: Procedure Experience
Number of ERCP procedures performed till date (approx.)
Number of UGI procedures performed till date (approx.)
Number of colon procedures performed till date (approx.)
Equipment's available
Olympus
Fujifilm
Pentax
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