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IEA - Online Application

This document provides information about applying for an online epidemiology course through the International Epidemiological Association (IEA). The deadline for applications is November 1, 2011. It includes an application form requesting information such as contact details, education history, publications, computer skills, and accommodation preferences. By submitting the application, applicants agree to participate in the full course running from May 7-18, 2012 in Lima, Peru.

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111 views

IEA - Online Application

This document provides information about applying for an online epidemiology course through the International Epidemiological Association (IEA). The deadline for applications is November 1, 2011. It includes an application form requesting information such as contact details, education history, publications, computer skills, and accommodation preferences. By submitting the application, applicants agree to participate in the full course running from May 7-18, 2012 in Lima, Peru.

Uploaded by

franz_sitepu
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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9/8/2011

IEA - Online Application


CONTACT US IEA COURSES Thursday, 08 September 2011

search...

ABOUT

PROGRAMME

APPLICATION

CONTACT US

Home

Application

Online Application

Online Application
APPLICATION FORM
Deadline for receipt of applications: November 1, 2011 Please answer each question clearly and completely. All relevant information should be included on this form. PLEASE COMPLETE IN ENGLISH.

* required fields
Prefix (*) First Name (*) Last Name (*) Professional address Address (*) Mailing address (if different) Address

City (*) State / Province (*) Country (*) Zip / Postal Code (*) Telephone (*) Cellular/Mobile Fax Email (*) Place of Birth Nationality (*) Date of Birth yr / mth / day Sex (*) Male Female

City State / Province Country Zip / Postal Code

EDUCATION AND EXPERIENCE


Qualifications (start with most recent) (*) Institution name and city From To Field of study Qualification

http://www.iea-course.org/index.php?o

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9/8/2011

IEA - Online Application

Present post Years of service (*): From Title of your post (*) Name and full address of the Institution or Agency, which employs you (if different from above) To

Tel Fax

List of relevant publications:

Present research experience and activities, including any previous epidemiology courses attended:

How do you think this course would benefit your future professional activities? (*)

OTHER QUESTIONS
1. Have you any experience of working with computers? (*) Yes No If yes, please specify the computer packages you are familiar with

2. Do you have a sufficient knowledge of spoken English? (*) 3. Are you a member of the IEA? (*) Yes No

Yes

No

4. What is your accommodation preference? (*) single room at US $1,000 sharing a room with another student at US $800 do not require accommodation - course fee only - US $500 Please note that the course is heavily subsidized and no discounts will be given.

http://www.iea-course.org/index.php?o

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IEA - Online Application


I understand that, if I am accepted, I must participate in the complete course, from 9 a.m. Monday, May 7th to 1 p.m. Friday, May 18th, 2012. I shall be responsible for the costs of my travel. My course fees will cover the costs of accommodation, breakfast and lunch during my stay in Lima, Peru. (*)

Submit

CONTACT US
Course Secretariat IS Event Solutions T. 450.550.3488 x114 F. 514.227.5083 Email

QUICK LINKS

Keep me Posted!

World Congress First Name(*) Last Name(*) E-Mail(*)

Submit

http://www.iea-course.org/index.php?o

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