7/28/2019 IFMSA Delegation-Prince Mahidol Conference 2014-Application Form

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IFMSA APPLICATION FORM FOR

PRINCE MAHIDOL CONFERENCE 2014

January 27th- February 2ndFull Name (Surname, First Name, Middle Name)

Age Date of Birth

Citizenship Place of Birth

Civil Status Passport Number

Passport Date of Issuance Passport Date of Expiry

Contact Number E-mail Address

Name of Medical School

Name of Degree Program

Year in Medical School Expected Year of Graduation

Name of NMO

Position in NMO (if any)

7/28/2019 IFMSA Delegation-Prince Mahidol Conference 2014-Application Form

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Please submit this form to globalhealthequity@ifmsa.org in MSWord form (not pdf), along with your curriculum vitae (Max. 3pages) and motivation letter (1 page).

How do I plan to finance my travel expenses?

Do I need a support letter from IFMSA for my personal fundraising?(Yes/No)

Past experience relevant to the conference theme and subthemes (3

sentences)

Three most important achievements1.2.3.

mailto:globalhealthequity@ifmsa.orgmailto:globalhealthequity@ifmsa.org