Young ESGAR Application Form
E-mail
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example@example.com
Your Name
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First Name
Last Name
Date of Birth
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Day
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Month
Year
Date
Institution (Hospital, City, Country)
*
I am a:
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Junior Resident (1st - 3rd year)
Radiologist
Senior Resident (4th+ year)
I hereby confirm that I am a member of ESGAR in good standing
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Yes
Do you have any suggestions, i.e. new initiatives that YE should launch or goals we need to achieve etc?
Please upload a copy of your CV and picture of yourself for our membership list:
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Thank you for filling out this form and welcome to Young ESGAR!
In case of questions, you can contact us via youngesgar@esgar.org
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