Bursary application form for BDIAP Home Countries applicants - Maastricht Pathology 2018 - British Division of the International Academy of Pathology

Please complete the online form below and submit it by 5th May 2018

If you have submitted an abstract to the meeting then please email that separately to nafisa.wilkinson@nhs.net

Please also send a passport-sized photograph separately to nafisa.wilkinson@nhs.net

Please do not register for the meeting until you have heard the outcome of the bursary application process. You will be given instructions on the registration process.

Name:

First

Last

Date of birth:

Gender:

Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone:

Area Code

Phone Number

E-mail:

National Training Number (for UK graduates):

Have you submitted an abstract for the meeting?:

Are you in a substantive consultant post?:

Date of appointment to consultant post (if applicable):

Are you a member of the BDIAP?:

Have you applied for a bursary elsewhere? If so please give details:

I understand that my data will be stored by the BDIAP and I may be contacted in the future by the BDIAP on matters relating to my application. This data will be stored in accordance with the BDIAP's data privacy policies and will not be released to third parties. I may request that my data is deleted at any time using the data deletion request form in the data privacy policies section of the website however I understand that my data is stored as a contractural necessity of my receipt of funding from BDIAP so that if I ask for my data to be deleted this will also mean that I am cancelling my application for this funding.