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  • Category: BSCRS
  • Published: Sunday, 15 February 2015 16:13
  • Written by BSCRS Webmaster
  • 15 Feb

 

 

 

I, ……………………………………………………………………………………………………..(name in capital letters),

Address for correspondence        Street and Number:………………………………………………………………

                                                           Postcode and City:……………………………………………………………….

                                                           Telephone:…………………………………………………………………………..

                                                           E-mail:…………………………………………………………………………………

practicing colorectal surgery in the following hospital(s):……………………………………………………

……………………………………………………………………………………………………………………(name and city)

Officially confirm my candidature for (please, indicate your choice)

  • Full member (can be Full member of the Section, the surgeon who is member of thePractices surgery in Belgium, has more than 50% of his activity devoted to colorectal
  • Surgery or is largely renowned as an expert in colorectal surgery
  • Royal Belgian Society for Surgery (titular, corresponding or ordinary member),
  • Ordinary member (can be Ordinary member of the Section, the surgeon who is member of the
  • Royal Belgian Society for Surgery (titular, corresponding or ordinary member), practices surgery in Belgium, has an interest in colorectal surgery
  • Associate member (can be Associate member of the Section a non-surgeon with special interest in colorectal disease)
  • Honorary member (can be Honorary member of the Section anyone considered to have
  • Made an outstanding contribution to the field of colorectal diseases)
  • Corporate member (can be Corporate member of the Section any member of a company
  • Or organization with an interest in colorectal disease)

I am interested in becoming a Board member of the Section (full membership is necessary)

  • Yes
  • No
  • Names of 2 colleagues Full members, who are prepared to act as referee supporting my candidature
  1. ……………………………………………………………………………………………………..(name, hospital and city)
  2. ……………………………………………………………………………………………………..(name, hospital and city)

Email            : This email address is being protected from spambots. You need JavaScript enabled to view it.

Fax                : 02/374.96.28

Send to        : Belgian Section of ColoRectal Surgery

                        C/o RBSS

                        avenue W.Churchill laan    11/30

                        1180                               BRUSSELS

 

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