Applicant's Details

First Name

Last Name

Phone Number

Shipping Address (For Virtual Attendees)

City

State

Country

Postal Code

Current Position

If other, please state position:

I will be registering this event as a:

As an attendee, I plan to attend this course:

This course is offered to Surgeons-in-Training who are specializing in congenital heart surgery. If you are registering as a Surgeon-in-Training, proof of status will be submitted when asked.

Yes

Affiliated Institution/Hospital

Number of Years at Affiliated Institution/Hospital

Number of Years Experienced in Congenital Heart Surgery

I am currently a member of the Society of Thoracic Surgeons (STS)

Yes

I consent to be photographed or video-taped on selected courses while I participate in this course.

Yes

I further authorize that the photographs and video clips of myself and my filled-in questionnaire may be used for publication or presentation for academic or promotional purposes in any form.

Yes

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Bootcamp 2026 - HOST (Hands-On Surgical Training) in Congenital Heart Surgery

Oct 16, 2026, 8:00 AM EDT – Oct 18, 2026, 12:00 PM EDTThe Hospital for Sick Children

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