21^st Residential Summer Course in Epidemiology
Florence, 23 June - 11 July 2008

Application form Please type in capital letters. All residents will be expected to follow the modules on epidemiological and statistical methods which will be all day in week 1 and 2. In the third week six special and optional modules are run, some of them in sequence and some concurrently. In order to allow an optimal programming and balanced distribution of students between modules please indicate which module(s) you wish to attend by ranking them from 1 (your highest priority) to 6 (your lowest priority).

To apply to the EEPE "21st Residential Summer Course" held in Florence from 23 June to 11 July 2008, please mark this case     and then proceed to indicate your priorities :   Rank Cancer epidemiology Fertility and pregnancy Epidemiology and environment part 1 : global climatic change and health Epidemiology and environment part 2 : local and occupational environment and health Epidemiology and environment part 3 : social environment and health Statistical methods in epidemiology 3 : analysis of follow-up studies Surname : First name : Mailing address : E-mail : Telephone : Nationality : Fax : Sex : Date of birth :     University or Higher Education : Educational institution : Approx. dates : Name of Course : Degree : Present employment : Employer : Address : Position held : Present work outline : Previous epidemiological training and experience : little some substantial extensive Your knowledge of spoken English is : excellent good moderate Students from low and middle income countries (as from the World Bank classification) intending to apply for a fellowship should also submit by e-mail (to secretary@eepe.org) a short curriculum vitae with publication list and an indication of the plan of the work envisaged for the year following the course. You confirm that you want to apply to the EEPE "2008 Residential Summer Course" ? YES