ssstdi . Society for the Study of Sexually Transmitted Diseases in Ireland

Describe the course/conference

Give date, time, location and duration, as well as the objectives, content etc. *

Who is the course/ conference aimed at? *

Personal and Professional Details

Name and Surname *

Academic Title(s) *

Current position *

Hospital/ Institute/ practice *

Address *

Email Address *

Telephone *

Mobile *

Professional Experience

Years of experience in field *

Motivation

Please provide us with your motivation to participate in the course/ conference and your expectations of how you will apply the new skills in your daily work *

Sponsorship requested

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Travel (economy class) *

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For registration *

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