EEPE COURSE
SOCIAL INEQUALITIES IN HEALTH IN EUROPE
Florence 14 June - 18 June, 2010

Application form

Please type in capital letters.

In order to apply the EEPE "Social Inequalities in Health in Europe Course" held in Florence from 14 June to 18 June 2010, please mark this case :     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 Have you attended an EEPE summer course ?   If "YES", in which year ? You confirm that you want to apply to the EEPE course "Social Inequalities in Health Course" 2010 ?  YES