Please list several dates that you can be available. We will confirm a date for your Preceptorship within 5 days of receipt of your Registration Form. Payment is required with registration to secure a date. We will confirm your date by phone or fax. If paying by check, you must print and mail the registration along with your payment.
ALL fields are mandatory.
Please do not leave any of the fields blank or your form will not be processed. By typing your name here you authorize to be charged the above amount as the registration fee for the specified Laparoscopic Preceptorship.