Application for an Educational Event in Association / Supported by ISUCRS

1 Applicant

Title *

First name *

Last name *

E-Mail Address *

Phone number (including international Country Calling Codes) *

2 The Meeting

Application for: *

Is the application on behalf of any local or national organization? *

City and country where the meeting is to be held. *

Suggested dates of meeting *

Are these dates coinciding with any major local/national/international meeting attracting colorectal surgeons? *

Will the meeeting be sponsored by any university/medical school? (If Yes - endorsement should accompany this form) *

Endorsement Form (see above) Choose file No file chosen

PDF, DOC, DOCX, JPG or PNG · max 8 MB. Required if the meeting is sponsored by a university/medical school.

3 Details

Please provide details of the meeting venue *

Detail the possibilities to finance the meeting (including availability of resources to promote a meeting).

Do you have well organized supporting group which can devote enough time for the organization of the meeting? Please detail.

What other support is offered by scientific or governmental authorities? *

4 Support & Confirmation

What support would you like from ISUCRS? *

Advertise the meeting on ISUCRS website? (All Events) Advertise the meeting in an e-flyer from ISUCRS? (All Events) Provide speakers for the meeting? (Only ISUCRS Lead Event) Assistance in creating the programme? (Only ISUCRS Lead & Supported Events)

By submitting this application you accept that ISUCRS will not give financial assistance.

Date *

Fields marked * are required.