Schedule a Procedure

Level 2

To start with your GESEA MIGS Diploma, please complete the form below to schedule a procedure and pay the fee. You need to do this for all 5 procedures as required for the level diploma to meet the requirements of the GESEA MIGS Diploma.

Please note that you will only be awarded the GESEA MIGS Diploma when you have submitted all 5 required procedures and when these procedures have been positively evaluated.

Last Name*
First Name*
Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Institute*
Academy or Winners ID*
Phone*
Email*
Procedure Selection and Payment
Specify the type of procedure and the date when the procedure will take place. When the procedure has been completed, you have 48 hours to submit the video of the operation. The payment fee covers all administrative charges, the review of the submitted materials and, upon successful review of all 5 procedures, an electronic version of the diploma.
Product Name*
Date*
DD slash MM slash YYYY
Total
0,00 €
Payment type*
- Credit Card
- Bank Transfer
Credit Card
Card Details
Cardholder Name
Payment details
European Academy of Gynaecological Surgery
IBAN: BE 03 3300 7314 1084
BIC: BBRUBEBB
Reference: Your name and session title
Consent*
I have read and agree with the terms of use and the privacy policy of the European Society for Gynaecological Endoscopy
Phone
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Schedule a Procedure

Procedure Selection and Payment

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