2014 IARC Summer School in Cancer Epidemiology

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Offered

Module 1
Module 2

Instructions:

Please complete electronically in English. Answer each question. All relevant information should be included on this form.

Please make sure that the support letter is completed and signed by your supervisor prior to completing the form (see template here).

Once your application submitted, you should receive an acknowledgement email. Should you encounter any problem to fill and/or submit the form, please contact the IARC Courses Programme, at cor@iarc.fr.

Deadline for receipt of applications: 14 January 2014.

Please enter your name as it appears on your passport

Family name/Nom de famille/Apellido *This question is required.

First name/Prénom/Nombre de pila *This question is required.

WORK ADDRESS (institution)

Institution

Street

City *This question is required.

State/Province

ZIP/Postal code

Country *This question is required.

Email *This question is required.

Telephone *This question is required.

Fax

PRIVATE ADDRESS
Communications will be sent to your WORK ADDRESS (documents, certificates,etc.)
If you want it to be sent to another address (private address), please provide it below (steet, number, city, state/province, zipcode/postal code, country)

Please indicate if you would like communications to be sent to your work or private address. *This question is required.

Work address
Private address

Gender *This question is required.

Female
Male

Age (number only) *This question is required.

Country of origin (nationality) *This question is required.

Have you ever attended any previous courses organized by IARC? *This question is required.

No
Yes. Please give details Please enter an 'other' value for this selection.

How did you hear about the IARC Summer School? (Multiple answers possible) *This question is required.

2014 IARC Summer School in Cancer Epidemiology - Application form