Fundamental Peripheral Nerve Surgical Course

To apply for the Fundamental Course, you must submit the following materials below.

Loupes required. (Experience with loupes is beneficial. Loaners may be available upon request.)

Note: Completion of course fills part of criteria to become AENS Fellow Physician.

The AENS Surgical Committee will review all applicants and are subject to final approval. Physicians can not be fully registered until all forms and payment is completed.

For questions, contact the main AENS office - 888-708-9575 or info@aens.us

*Required field(s) are indicated by an .**
* First Name
* Last Name
* Professional Designation (MD, DPM, etc...)
* Main Address
* City
* State
* Zip
* Phone
* Email
* Referral by an AENS member surgeon
Please upload the supporting documentation using the Browse buttons below. NOTE: each file upload is limited to 25 MB in size.
* CV
Course Fee Due - $2595
* Name	Name as it appears on the credit card
*Billing Address
*Billing Zip
Type
* Number	Credit Card Number
* Card Security Code	Card Security Code
* Exp. Date	mm/yyyy