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Working to facilitate rapid translation of scientific discoveries into therapeutics

PCPH 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: PCPH 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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