Application form

Application Form
  1. Personal Data
    1. Please provide the following information about yourself.
  2. Professional background
    1. Please provide the following information about your professional background.
  3. Education
    1. Please provide information about your academic background - starting with your highest academic degree.
  4. English language skills
    1. This short course is held in English. Therefore, participants have to be proficient in spoken and written English.
  5. Statement of Motivation
    1. Please provide a brief statement (max. 300 words) outlining why you would like to attend this course and what benefits you hope to gain from participating in it.
  6. Additional comments
    1. Any other information you wish to communicate to the organisers?
    1. You will find the privacy statement here.
    2. Please note if you have been offered a place on the course you will be asked to provide proof of your highest academic degree and you will be required to bring formal ID (Passport).
  7. * These fields are required

  8. Send Application Form

COURSE DETAILS

Course dates

3-21 Sept 2018

Course fee

800 € - 1750 €

This course is formally recognised by the Hamburg State Medical Chamber.
Dieser Kurs ist von der Ärztekammer Hamburg anerkannt. 

Contact

Dr Dewi Ismajani (Jani) Puradiredja

Department of Infectious Disease Epidemiology

Bernhard Nocht Institute for Tropical Medicine
Bernhard-Nocht-Str. 74
20359 Hamburg

Tel: +49 (0)40 428 18-243
Email: shortcourse(at)bnitm.de