Winter School on EEG and Epilepsy 27th February – 3rd March 2018 APPLICATION FORMFirst name: * Last (Family) name: * Nationality: * Year of birth: * Gender: *MaleFemale Current position /affiliation: * Address * Email * Telephone: * Specialty/degree: * Obtained in year: * Training in EEG:Institute / Department: * Number of years: * Do you wish to apply for bursary (please check)? *YesNo Will you be able to attend the course only if you receive bursary? *YesNo If you apply for bursary, please justify your request in the box below: * Please describe shortly why you would like to participate in this EEG course: * Please send the application form, a short CV (max. 2 pages + publication list) and a recommendation letter to: drhassanhosny@yahoo.com Deadline for application: December 31, 2017 VerificationPlease enter any two digitsExample: 12This box is for spam protection - please leave it blank
