Fellowship Application
Udskriv denne side
This application must be accompanied by a complete fellowship plan that should be sent to the Scientific Secretary of EACTA. Without a complete plan the application cannot be processed further.

Fellowship Application

Please fill out this form - click the OK-button and follow the instructions.

Last Name:
First Name:
Title/Position:

Office/Institution:
Department:
Office Address:
City:
State:
Postal Code:
Country:

Tel.:
Fax:
E-mail:

Home Address:
City:
State:
Postal Code:
Country:

Preferred mailing address:

Office
Home

Support from home institution:
(Head of Department/Hospital administrator)

Name:

Institution to visit:

Name:
Department:
Address:
Zip:
City:
Country:

Contact person at Institution:

Name:
E-mail address:
Fax number:
Preferred/Agreed
Starting time:

Seeking Fellowship for:

12 month
6 month

Benefit and achievement from visit:
(max 255 characters)

Benefit and achievement:

   
Advertisement




Latest News
JCVA



The Journal of Cardiothoracic and Vascular Anesthesia (JCVA) is now the official journal of the European Association of Cardiothoracic Anesthesiologists (EACTA)......

» Read more