Application Form

If you are interested in participating at the course please fill in the following form (expression of interest) and send it along with your CV.

Thank you very much for your help and cooperation.

Title *
Name *
Surname *
Occupation *
Address *
Tel *
Fax *
Email *
Is the organization you work for able to cover your travel expenses (air-tickets)? *	Yes No
Are you a medical doctor or nurse (civilian or military)? *	Yes No
Are you a medical CBRN expert? *	Yes No
Do you have experience in training other health workers? *	Yes No
Are you able/willing by appointment or due to your current position to reproduce such course in your country? *	Yes No
Upload your CV


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