AO ASIF Comprehensive Spine Course
Registration Form

Please do not consider yourself registered for this course until written confirmation is received.

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Course Name:

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Name:

Degree(s):

Social Security Number (For documentation purposes only):

Guest's Name (if any):

Home Address (Street address only - No P.O. Box):

City:

State:

Zip:

Phone (office):

Phone (home):

Fax Number:

E-mail Address:

Hospital Affiliation:

City:

Have you ever attended an AO ASIF Course?: Yes No
If yes, when and where?:
Tuition Enclosed - U.S. currency only
Comprehensive Course-$825.00
Residents (Comprehensive Course only)*-$675.00

*Enrollment is limited to residents who have attained a PGY 5 level and above. A letter from the Program Director must accompany the registration form and payment to qualify for the reduced Resident tuition.

Please mail this Registration Form and payment to:

AONA Continuing Medical Education
Re: Quebec Comprehensive Spine Course
1690 Russell Road
Paoli, PA 19301
Tel: (800) 769-1391/(610) 695-2459
Fax: (610)695-2420

Or submit online using a credit card.

Enclosed is my check for $ made payable to: AO ASIF Continuing Medical Education

Charge my credit card:

(American Express not accepted)

Master CardVISAExp.Date: Card Number:
Signature (all credit card orders must be signed if mailing or faxing form):

PRE-COURSE QUESTIONNAIRE-MUST BE COMPLETED FOR REGISTRATION FORMS TO BE PROCESSED

2. Special Training: (check one) Neurosurgery Orthopaedic Other

3. As a participant in the Comprehensive Course, please check off what you expect to learn from the Course.
Basic knowledge of functional anatomy, biology and biomechanics of the spine
Preoperative planning methods
AO principles of the spine
Surgical approaches
Apply AO principles in traumatic, degenerative and inflammatory processes affecting the spine
Complications of spine surgery
Perform relevant psychomotor skills in the practical application of spinal impants to artifical bones
Outcome analysis
Other

Please do not consider yourself registered for this course until written confirmation is received.

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