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  • Application Form

    FOR NEUROSURGICAL EQUIPMENT:
    WFNS CRANIAL SET,
    WFNS SPINAL SET,
    WFNS BIPOLAR COAGULATION SET,
    WFNS HIGH-SPEED DRILL SET,
    WFNS ENDOSCOPY SET
    and WFNS MICROSCOPE


    CRITERIA TO BE FULFILLED WHEN REQUESTING WFNS NEUROSURGICAL EQUIPMENT

    (WFNS Cranial, Spinal, Bipolar Coagulation, High-Speed Drill Sets and WFNS Microscope)

    Any person requesting neurosurgical equipment from WFNS should fulfill the following requirements:

    1. Be a qualified and practicing neurosurgeon.
    2. Be a member of a WFNS member society, which is in good standing with WFNS and not in arrears of payment of membership fees.
    3. Have the approval of the President and/or Secretary of the Society of which you are a member.
    4. Fill in, date and sign the WFNS Application Form and return it to the WFNS Central Office by email or fax.
    5. Purchase the neurosurgical equipment yourself or jointly with one or more other neurosurgeons for use at a public hospital.
    6. In the case that you do not have the funds necessary to purchase the neurosurgical equipment, you must seek a donation from the Society of which you are a member or try the utmost to find a sponsor elsewhere.
    7. Confirm that the neurosurgical equipment requested will not be used in a Private Hospital or Clinic where high fees are charged for treating patients.
    8. Confirm that the neurosurgical equipment requested is not for your personal use.
    9. Request only 1 set of neurosurgical equipment, per Hospital, unless purchasing it yourself or through a sponsor.
    10. Agree to the possibility of being listed on the WFNS website for having received neurosurgical equipment through WFNS at the reduced rate.
    11. Be willing to provide a report and photographs from time to time or upon request, regarding the performance, use and efficiency of the neurosurgical equipment.

    (Please carefully read the "Criteria" before filling in this form)







    (*Please precise exact number of each)

    (in the space below, please state your reasons and precise exactly what you require)
    N.B: If your request is approved, the person making the bank transfer should kindly instruct the bank to indicate the correct reference number corresponding to the neurosurgical equipment requested, in order that the payment can be easily identified on its receipt.