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Working to facilitate rapid translation of scientific discoveries into therapeutics

PCCR Application Form

    Application Type*

    Category 1 (without qualifying examination)
    Category 2 (with qualifying examination)
    Either

    EUSTM Membership*

    Yes
    No

    Your Name*

    City

    Country

    Email

    Section 2: Expertise Areas / Disciplines





    Section 3: Academic Record





    Professional Experience (Last 3 years)



    Section 4: Talks / Presentations / Posters



    Section 5: Memberships (Professioanl / Scientific / Medical organziations)





    Awards / Achievements / Honors





    Section 6: PCCR Support Statement


    CV/Resume*


    Section 7: Declaration & Check List


    I confirm that information provided in the form and in my CV are accurate.
    I have attached the CV/Resume
    I confirm that I have read and obey the Academy’s Rules, Regulations and policies.

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