Application Form
Name of Applicant: _____________________________ Title: ________________
Unit and Institution: ___________________________________________________
Address: _____________________________________________________________
Telephone: __________________________ Fax: ___________________________
Meeting to be attended: ________________________________________________
Organization of the Meeting: ___________________________________________
Title of the Abstract: __________________________________________________
____________________________________________________________________
Authors of the Abstract: ______________________________________________
____________________________________________________________________
Status of the applicant:
Nephrology trainee / Fellow / Nurse / Medical Technologist / Scientist / Allied Health Professional
Status of membership: Full / Associate
Declaration by the applicant: