IPNA Nephrologist in Training Subscription Application

IPNA Nephrologist in Training Subscription Application
Name*

First NameLast Name
Email*
example@example.com
Birth Date*

MonthDayYear
Date
Nationality*
Nationality*
Country of residence*
Gender*

FemaleMaleOther
Fields of interest (max 5)*

Developmental nephrology and CAKUTNeonatal nephrologyNephrotic syndromeHUSGenetic and hereditary kidney diseasesTropical disease affecting the kidneysAKICKDDialysisTransplantationEpidemiological research
Please select which IPNA programs/areas are of interest to you:*

IPNA educational activities and CurriculumIPNA Fellowship programIPNA Sister Unit programIPNA Mentorship programIPNA Clinical Research AcademyIPNA social media activities
Nephrology program supervisor name:*

TitleFirst NameLast Name
Email*
example@example.com
Contact Number*

Area CodePhone Number
Institution*
Current year of training:*
E.g. 2 = I am in year two of my program
Total duration of training program in years:*
E.g. 4 = 4-year training program in total
Exact end date of the training*

MonthDayYear
Date
Membership length
Profiles interest
Profiles programs
Profiles years
Please upload a confirmation from the Nephrology program supervisor*

Cancelof
CLICK HERE to download the template
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