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Belt & Road Training Program in Minimally Invasive Gastrointestinal Surgery

Application for the International Training Workshop on Laparoscopic Gastrointestinal Surgery

Please complete the form below to apply for the training program. Selected applicants will receive further confirmation and administrative instructions by email.

A. Applicant Information

Full Name

Gender

MaleFemale

Date of Birth

Nationality

Passport Number

Profile Photo / Headshot

Click to upload photo

B. Professional Information

Institution / Hospital

Department

Current Position

Professional Title

Specialty

Years of Clinical Practice

Experience with Minimally Invasive Surgery

C. Training Background

Previous Training in GI Minimally Invasive Surgery

YesNo

Experience in Laparoscopic Surgery

NoneBasicIntermediateAdvanced

Experience in Robotic Surgery

NoneBasicIntermediateAdvanced

English Proficiency

BasicIntermediateAdvanced

Main Clinical Interests

Expected Learning Objectives

D. Contact Information

Email Address

Mobile Number

WhatsApp / WeChat

Emergency Contact Name

Emergency Contact Number

E. Travel & Administrative Support

Do you need an official invitation letter?

YesNo

Do you need accommodation assistance?

YesNo

Planned Arrival Date

Planned Departure Date

Dietary Restrictions / Special Needs

F. Supporting Documents

Curriculum Vitae (CV)

Upload PDF

Passport Copy

Upload PDF

Recommendation Letter

Upload PDF

Medical License / Professional Certificate

Upload PDF

Declaration

I confirm that all the information provided is true and complete.I agree that my information may be used for application review and program administration.

B@R AMIS

Belt & Road Alliance for Minimally Invasive Surgery

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About Program Contact

Contact

+86 731-8975-XXXX

Xiangya Hospital, Central South University, Changsha, Hunan, China