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To apply for a Bursary from the British Division of the International Academy of Pathology, print this web page out, fill in the form legibly and post it to:

Dr Nafisa Wilkinson, c/o Mrs Carol Harris, P.O.Box 73, Westbury on Trym, Bristol, BS9 1RY, U.K.

 


Application Form for Nermin Durakovic BDIAP Bursary to attend IAP & ESP Congress, Cologne, 25th - 30th September, 2016

Your name:

Your address (For correspondence):

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Your address (Place of work, if different from the above):

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Your e-mail address:

Medical qualifications:

Date of medical qualifications:

Your date of birth:

Your present age:

Information about your laboratory

Population served by your laboratory:

Total number of histopathology specimens per year:

Total number of autopsies per year:

Number of full-time equivalent histopathologists (NOT trainees):

Information about your proposed trip

Conference days you wish to attend:

Details of your conference presentation or poster. Please note that applications will not be considered without an abstract

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What is the return fare (Economy) in Pounds Sterling
between your nearest airport and an appropriate airport in the area of the meeting?

 

Please give the names, postal addresses and (if available) email addresses of two pathologists, one of whom should be your Head of Department, who are willing to support your application with a reference.

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Give a BRIEF summary of your training so far, and your future plans.

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Explain briefly how this experience would benefit your institution and the population it serves.

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We regret that it may not be possible to acknowledge receipt of applications. Successful applicants will be informed by e mail or post.