|
Full Name (Surname, First Name, Middle Name) | |
Age | Date of Birth |
| |
Citizenship | Place of Birth |
Passport Number | |
| |
Passport Date of Issuance | Passport Date of Expiry |
| |
Contact Number | E-mail Address |
| |
Name of Medical School | |
Year in Medical School | Expected Year of Graduation |
| |
Name of NMO | |
Position in NMO (if any) | |
World Diabetes Congress
(2nd- 6th December 2013 in Melbourne, Australia)
Write a motivation letter (Max 100 words). |
Past experience relevant to the conference theme and subthemes (3 sentences) |
Three most important achievements |
1. 2. 3. |
Please submit this form to lph@ifmsa.org in MS Word form (not pdf).
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