37th Course on Microsurgery of the Middle Ear and Auditory Implants

February 24th – 26th, 2025 Department of Otorhinolaryngology Plastic, Aesthetic and Reconstruction Surgery • University Hospital of Würzburg • Josef Schneider Str. 11 • D-97080 Würzburg / Germany • www.ukw.de/hno Course fees: - 450€ Course fee /personal participation) - 950€ course fee (personal participation) - including temporal bone exercises (two sessions, each 180min., one specime for preperation) - 200€ course fee (online participation) An Email confirmation will be sent upon receipt of your registration form. Please inquire if the confirmation does not reach you two weeks after your sending. Payment must be received two weeks after Email confirmation, otherwise we cannot maintain your registration.

Hinweis: Mit Sternchen markierte Felder sind Pflichtfelder.

Course on Microsurgery of the Middle Ear and Auditory Implants

Conference Registration Form

(please register by 31.12.2024)

I. Participation

Please select how you would like to participate:*

I would like to participate in person in the Course on Microsurgery of the Middle Ear and Auditory Implants.

I would like to participate in person in the Course on Microsurgery of the Middle Ear and Auditory Implants including the temporal bone exercises (two sessions, each 180 min., one specimen for preparation, limited vacancies).

I would like to join the course online (restricted places, you will receive the dial-in information in due time before the event)*

Es muss eine Auswahl getroffen werden.

If you have any questions regarding the face-to-face event please contact Mrs. H. Kempf kempf_h@ukw.de phone +49 931 201-21323 fax +49 931 201-21321

II. Participation in the social program on February 24th, 2025

I am interested to participate in the social program at the Staatlicher Hofkeller Würzburg

No, I do not wish to participate in the social program.

Es muss eine Auswahl getroffen werden.

Additional participant/s (50 € per additional person / the applicants participation in the social program is already included in the course fee.)

III. Participant

Please enter your name as you wish it to appear on your badge.

Title* Das Feld darf nicht leer sein.

Family name* Das Feld darf nicht leer sein.

First name* Das Feld darf nicht leer sein.

Hospital / Medical office

Private address

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Postal code* Das Feld darf nicht leer sein.

City* Das Feld darf nicht leer sein.

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Work phone

Work fax

Email* Das Feld darf nicht leer sein.

Dietary requirements

Storage of contact data for information about other events*

If you give us the consent to inform you about further events at the University Dept. of Otorhinolaryngology, Würzburg / Germany your contact data will be stored until you revoke your consent

I agree with the storage of my data.

I do not agree with the storage of my data.

Es muss eine Auswahl getroffen werden.

Consent to Use of Data*

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I consent to the processing of the above data in the context of this event. I can revoke this consent at any time for the future towards the organizers. The revocation has no retroactive effect. The data processing until revocation remains legal. I have taken note of the instructions for handling my data by the course organizers. For further information, please see our Privacy policy (available in German language).*

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