Registration Form

You are required to complete and submit the below form once you have been appointed as an AGES Trainee.

This online form will be automatically submitted to the AGES Secretariat.

  • Trainee Details

  • You will receive an automated confirmation email once this form has been submitted.
  • Registration

  • Education

  • Degree / QualificationsOrganisationDate 
  • AGES Fellowship Position

  • Training UnitTraining DirectorDate of EngagementCommencement Date (mm/yyyy)
  • Affiliation

  • Associate/Member/FellowOrganisation/Association 
  • I certify that I have no restrictions, conditions or any other limitations on my medical registration(s) and that the information contained in this application is true and accurate and I provide the acknowledgements above. Whilst AGES is facilitating the administration of fellowship positions in the AGES Training Program in Gynaecological Endoscopy to be offered by accredited training units, the responsibility for education, training and assessment will rest solely with the individual Unit offering the position.
  • DD slash MM slash YYYY
  • Training Director

  • Director NameInstitutionCountry
  • DD slash MM slash YYYY
  • This field is for validation purposes and should be left unchanged.

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