Fourth Short Course on Abdominal Ultrasound in Tropical Medicine

Application Form


Name...............................................................................................................

Highest Study Degree / Year .......................................................................................
...................................................................................................................

Address............................................................................................................

Telephone .........................................................................................................

Fax ...............................................................................................................

e-mail ............................................................................................................

Specialisation / Subspecialty or Area of Interest .................................................................

Nationality........................................................................................................

Present or most recent position

Name of employer...................................................................................................

Previous experience in ultrasound .................................................................................


Plans to use ultrasound in tropical context .......................................................................
...................................................................................................................
...................................................................................................................
...............................................