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Microsoft word - international application form.doc

International Application Form
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Street ___________________________________________________________________________ Town ___________________________________________________________________________ Postcode ___________________________________________________________________________ Country ___________________________________________________________________________ Telephone ___________________________________________________________________________ _________________________________________________________________________  ___________________________________________________________________________ Nationality ___________________________________________________________________________ Father’s Occupation ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ _________________________________________________________________________  ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Suggested travel destination _________________________________________________________________________   yes  no Do you need an invitation to get a visa?  yes  no ___________________________________________________________________________ _________________________________________________________________________  How did you hear about zis? ___________________________________________________________________________ Annotations:
 applications are only accepted with a valid e-mail-adress the applicant can access regularly. All communication between zis and the participants is
 zis never awards grants to young people who already attend university or college. Please refrain from applying if you will be already enrolled at the  please specify country and region  zis has only very limited possibilities to support candidates in obtaining visa  compulsory for all applicants even if over 18 years of age
Please fill in the form and add all additional material (e.g. project outline and budget plan) zis needs in English or German
language. Applications must be sent via conventional mail. For details, see or our leaflet in English.
Incomplete applications will be neither processed nor answered. Deadline for every year is February 15.

zis Stiftung für Studienreisen • zis Foundation for Travel Grants
c/o Schule Schloss Salem • D-88682 Salem • Germany Telephone +49 7553 919332 • Telefax +49 7553 919301 • •


COMPTE RENDU DE LA CELLULE GESTION DES RISQUES DATE : 25/09/2012 Présents : M. Leguédois, A. Atbib, C. Divay, C. Eury, S. Guillard, R. Meurou, V. Hamel, V. Vaultier, L. Bréard, A. Giudicelli, M. Eury Analyse des signalements d’évènements indésirables o 2 évènements indésirables dont 1 grave o 6 incidents absence du médicament (Rémicade) pour une patiente accueil ie en

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BRIAN S. KAHAN, D.O. CURRICULUM VITAE Business Address: Business Phone: BOARD CERTIFICATION American Board of Physical Medicine and Rehabilitation American Board of Physical Medicine and Rehabilitation- Pain Subspecialty Fellow Interventional Pain Physicians American Osteopathic Board of Physical Medicine and Rehabilitation American Board of Pain Med

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