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Application form EPA Course - Utrecht 2020

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Course dates: June 11-13, 2020

Course location: University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht

Application steps

Step 1: Filling out the application form before April 1, 2020.

Step 2: Confirmation from the course administration with invitation to pay the course fee.

Step 3: Final confirmation of acceptance in the course after receiving the payment.

Application form - EPA Course Utrecht

Full name

Institution

Credentials (degrees, titles)

Contact information. Including mailing address and phone/fax number

Biosketch, please provide a brief biographical sketch (job title, position, association, specialty areas, research interests, etc.) in the space provided (max 200 words).

Motivation, please explain your motivation for attending the course, including your experience with EPAs (max 200 words).

Do you agree to share your name and biosketch in the course materials provided to all course participants? Yes, I agree

Additional information. Please enter any additional information you may have.

Other courses, would you like to be considered for one of the alternate course locations if we are not able to accept you for the Utrecht course? April 30 - May 2 2020, Washington DC, United States September 17-19 2020, Bogota, Colombia (In Spanish)

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