Train the Trainers Mendoza - Participant Nominations

2023 Train the Trainers Pereira Participant Nomination Form

Application Deadline: 1 June
Participant Arrival Date: Tuesday, 15 August 2023
Workshop Dates: 16-18 August 2023
Participant Departure Date: Friday, 18 August 2023
Recommended Audience
WGO Member Societies and WGO Training Center Directors may nominate up to two candidates who meet the qualifications below:
- Must be fluent in Spanish and have at least a proficient level in English
- Open to Gastroenterologists, Hepatologists, Endoscopists, or GI Surgeons
- Is responsible for or looking to train other healthcare professionals and would like the opportunity to enhance their leadership and training knowledge and skills.
- Participants are required to attend the entire workshop and should plan to arrive on the specified arrival and departure dates listed above.
- Participant will commit to putting the TTT workshop lessons into place upon return to their own teaching environment.
Application Review
Applications will be reviewed by for adherence to the above criteria and for equal geographical, gender and expertise distribution. Priority will be given to WGO member societies that have paid their dues through 2022 and WGO Training Centers that have completed their 2022 WGO Annual Report.

Applications will be reviewed in June 2023 with notifications going out later that month to both the nominator and nominee via email.

Venue
Hotel Movich Pereira
Cra. 13 #No 15-71, Pereira, Risaralda, Colombia

Travel
Participants are required to cover their own hotel and travel to and from Pereira, Colombia. There is no registration fee to attend TTT or the Colombian-Venezuelan Regional Course wich will take place from 18-19 August (only for those TTT participants who wish to stay after). Participants may select their own hotel in Mendoza.

Medical Insurance
Participants are responsible for obtaining their own medical insurance while attending the workshop. WGO does not provide medical coverage for participants.

Visas
A letter of support and any course-related documentation needed to assist in obtaining a visa can be provided upon request. Please note that WGO is unable to contact the Embassy on your behalf. It is the responsibility of each participant to make the necessary arrangements related to this process.

Please note:
- Participants are responsible for securing their hotel accommodation, flight and transportation to and from their arrival destination (airport, train station, etc…) and the Hotel Movich Pereira.
- The participant acknowledges by registration, that he/she has no right to lodge damage claims against the organizers in the event of cancellation due to unexpected events / force majeure or changes to program due to any reason.
- Should participants wish to bring their partners with them to TTT they will be charged for the additional rooming costs along with social event and meal expenses.
- Participants who wish to arrive before or depart after the specified arrival and departure days, must clarify their accommodations and other personal expenses which may occur (ground transportation, meals etc.) directly with the hotel.
I certify that my nominee(s) meet the recommended audience qualifications, that they understand the workshop attendance requirements, as well as all other terms outlined above.

Yes
Please note that this application must be filled out by either a WGO Member Society Leadership Representative or Training Center Director, who received the initial email announcement from WGO. Otherwise, please reach out to the representative from your society or Training Center and request they fill out the application to nominate you so your nomination can be considered.

Two candidates can be nominated on the same application from either the Member Society or Training Center.

Are you a Training Center Director or WGO Member Society Representative*

WGO Member Society RepresentativeWGO Training Center Director
Society Representative or Training Director Nominator Name*

First NameLast Name
Nominator Primary email address*
example@example.com
Nominator Secondary email address
example@example.com
Name of WGO Member Society*
Position in your Society*

PresidentVice PresidentChairmanSecretariatExecutive DirectorExecutive Officer
I certify that I am able to represent my society and have the authority to nominate a Train the Trainers participant(s).*

YesNo
I understand that the society I am representing must pay their WGO membership dues through 2021 to have the nominee(s) considered for the 2022 Train the Trainers workshop.*

YesNo
Name of WGO Training Center
Position at WGO Training Center
I certify that I am able to represent the above WGO Training Center and have the authority to nominate Train the Trainers participant(s).*

YesNo
I understand that I need to have completed the 2022 WGO Training Center Annual Report in order to have nominee(s) considered for the 2023 Train the Trainers Workshop.

YesNo
Please answer the following questions for your FIRST CANDIDATE NOMINATION.
Name of first candidate*

First NameLast Name
Primary email*
example@example.com
Date of Birth*

DayMonthYear
Date
Gender*

FemaleMale
Is the candidate fluent in Spanish?*

YesNo
What other language(s) is the candidate fluent in?

EnglishSpanishFrench
Address*

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Place of Employment (Name of Institution)*
Professional Title*
Area of Expertise*

GastroenterologyHepatologyEndoscopyGI Surgery
Will the candidate require a visa to attend the Train the Trainers workshop?*

YesNo
In 2-6 sentences, please briefly describe how this workshop will influence and/or enhance the candidate's abilities to train other health professionals as a result of attending the TTT workshop: *
Do you wish to submit a second TTT candidate nomination?*

YesNo
Please answer the following questions for your SECOND CANDIDATE NOMINATION.
Name of second candidate*

First NameLast Name
Primary email*
example@example.com
Date of Birth*

DayMonthYear
DD-MM-YYYY
Gender*

FemaleMale
Is the candidate fluent in Spanish?*

YesNo
What other language(s) is the candidate fluent in?

EnglishSpanishFrench
Address*

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Place of Employment (Name of Institution)*
Professional Title*
Area of Expertise*

GastroenterologyHepatologyEndoscopyGI Surgery
Will the candidate require a visa to attend the Train the Trainers workshop?*

YesNo
In 2-6 sentences, please briefly describe how this workshop will influence and/or enhance the candidate's abilities to train other health professionals as a result of attending the TTT workshop.*
Should be Empty:

2023 Train the Trainers Pereira Participant Nomination Form

Please answer the following questions for your FIRST CANDIDATE NOMINATION.

Please answer the following questions for your SECOND CANDIDATE NOMINATION.