Dermatology and Venereology for Ukraine – Congress 2022 Scholarship – EADV | European Academy of Dermatology and Venereology

Dermatology for Ukraine - Congress 2022 Scholarship

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Dermatology and Venereology for Ukraine

Please fill out the form below to submit your application for a free registration to EADV Congress 2022 virtual event.

If you are a member of the EADV (European Academy of Dermatology and Venereology) and does not wish to resubmit all your documentation, you may contact scholarship@eadv.org , and your participation in the virtual congress with be created from the back-office. Applicants who are not members of the EADV must fill in the form and provide the required documentation to be eligible for this scholarship.

Email*

Name*

Prefix First Last

Gender*

Male

Female

Birth date*

Nationality*

Country of residence / Working country*

Institution / Company*

Address (private / work)*

Street Address City ZIP / Postal Code Country

Healthcare Professional*

Yes

No

Please upload short CV*

Max. file size: 128 MB.

Please upload a copy of your passport or ID*

Max. file size: 128 MB.

Please upload:

- an up-to-date certificate indicating training in Dermatology and/or Venereology signed and stamped by your head of department

OR

a certified English translation of your diploma stating you are a specialist in Dermatology and/or Venereology

OR

an official letter in English from your National Society certifying that you are a Specialist in Dermatology and/or Venereology

Please upload a copy of your passport or ID*

Max. file size: 128 MB.

I confirm that the information provided is correct at the time of submission and I hereby agree to the "Registration Terms and Conditions” of the EADV Congress 2022 as well as to the “EADV Terms of Use”.

Consent*

I consent*

I confirm that if I get this scholarship, I will use it only for support of educational and scientific activities purposes for this event.

Consent*

I consent*