EUROPEAN SOCIETY OF THORACIC SURGEONS
European Society of Thoracic Surgeons
School of Thoracic Surgery
Scholarship Application for Knowledge Track and Skill Track Courses 2018
PLEASE COMPLETE IN BLOCK LETTERS
Surname: ……………………………………………………………… First Name ……………………………………………….
Date of birth: DD/MM/YYYY
Status (delete as appropriate): Trainee / Surgeon
Name of the institution you are currently working: …………….……………………………………………………
Institution Address: ……………………………………………………………………………………………………………………………
City: ……………………………………………. Country: ……………………………………….
E-mail 1: ...........................................................E-mail 2: ...........................................................
Are you an ESTS member (tick as appropriate): YES / NO
Predominant practice (tick as appropriate): Thoracic / Cardiothoracic / General Surgery / Other
Your training has started (complete here if you are a trainee): DD/MM./YYYY
Your training has finished (complete here if you have completed training): DD/MM/YYYY
Which School course you are applying to
( Knowledge Track: ‘Antalya Revisited in Prague’ 19 - 24 March 2018
( Skill Track: ‘Elancourt in Copenhagen’ 8 - 9 February 2018
Copenhagen Academy for Medical Education and Simulation
Topic: “Trachea and Major Airways”
Please explain the reasons for applying to this Scholarship:
Please return this form via e-mail to: Sue Hesford, ESTS Secretariat, sue@.uk
Closing Date: Friday 1 December 2017
No priority is given to selection based on the date of submitting the application
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