Bursary Application for

Bursary Application for

Epidemiology Course 6-7 July, 2012


EULAR - Bursary Application System
Please fill out the form carefully.
All fields marked with * must be filled out

Personal information
Family name* First name(s)*
Address street 1* Address street 2
Zip code* City*
Gender* Female       Male
 Country*
Phone number* Fax number
Email* Date of birth*
Working unit information
Academic degree* Date of thesis*
Unit name*
Unit address 1* Unit address 2
Unit zip code* Unit city*
Unit country*
Unit phone number* Unit fax number
The reason for your application*
Additional information and supporting documents
I have received a bursary from EULAR in previous years No    Yes (Please specify below)
course, congress, year, amount in EUR etc.
Document Attachment:
Please select the files to be uploaded by clicking the button below on right side of the upload field(s).
Only Word documents (.doc or .rtf) and Acrobat (.pdf) can be attached.

Please make sure your uploaded document(s) is properly formatted and not protected by a password.

Important information for Mac-users:
Please ensure your files are named properly including a file extension like doc, rtf or pdf.
Please upload your CV*
Please upload your list of publications
Please be aware that this procedure can last for several minutes.
You will receive a confirmation on your screen after successful submission.