APPLICATION FORM (DUE BY August 15th, 2012) Complete and Send to firstname.lastname@example.org
METODOS EN EPIDEMIOLOGÍA CLÍNICA RESPIRATORIA (MECOR) MÉTODOS EM EPIDEMIOLOGIA CLÍNICA RESPIRATÓRIA (MECOR) METHODS IN EPIDEMIOLOGIC, CLINICAL & OPERATIONS RESEARCH (MECOR) November 5th thru 10th, 2012 – Pelotas, Brasil
LEVEL 1: INTRODUCTION TO CLINICAL RESEARCH METHODS Is appropriate for clinicians and academicians who are engaged in the clinical practice of respiratory and sleep medicine, public health, allergy and critical care and wish to improve their skills in clinical research and investigation. No prior experience with research is needed. The textbooks used are Epidemiology by Leon Gordis (2nd Edition, Saunders) and Research Methods for Promotion of Lung Health, published by the Union (previously the International Union Against Tuberculosis and Lung Disease). LAST NAME
NUMBER & STREET ADDRESS
HOME TELEPHONE # *** Please include country and city codes
ATS MEMBER # (if member)
ALAT NUMBER# (if member)
E-MAIL: Important : MECOR staff COMMUNICATE with applicants by e-email. You **MUST** provide a reliable email address and check it frequently!! PLEASE WRITE CLEARLY !!
INSTITUTION/HOSPITAL/AGENCY WORK TELEPHONE# DEGREE Requirement : Those of you living in Pelotas area must consider dedicating your full attention to the course during this week You will not be able to attend to your normal work and family activities. The course is very intense. I.
CURRICULUM VITAE Please attach a brief C.V. that describes your training, degrees held, experience, and publications.
ESSAY (English only) Please attach a brief summary (not more than one page) of your interests, responsibilities and experience (if any) with research, teaching, public health and epidemiology. Include a brief paragraph about your expectations for this course, your professional goals and indicate how you expect to be able to use the information you gain in this course in your professional life. Please be as specific as you can.
TUITION Tuition for Introduction to Clinical Research Methods is $200 US. Payment will be due on September 15th after you have been notified of your acceptance. Applicants will be notified of their acceptance within fifteen days of the application deadline. Credit card payments (Visa, MasterCard, and American Express) are preferred.
Comments or Questions : _______________________________________________________________________________________ _______________________________________________________________________________________ Please Complete this Application form with Curriculum Vitae, Essay for receipt by August 15th, 2012. (Once received by Application Assistant, applications will be forwarded to Dr.Mara Tellez Rojo, Course Director, and Dr. Ana Menezes, MECOR LA Director) Applicants will be notified of the decision by August 31st, 2012 For more information contact: Gabriela Pati単o, Application Assistant e-mail: email@example.com fax : 54-351-485-3316