ISSM Endorsement Application Form

ISSM Endorsement Application Form
ISSM is committed to advancing quality education for sexual medicine world-wide. We are interested in partnering with well-qualified individuals to disseminate evidence-based knowledge that is free of commercial bias. Applications will be reviewed based on the following criteria: Qualifications of the Program Chair and proposed faculty; clinical relevance of the program; evidence-based merit of the proposed program; potential application of knowledge following completion of the program; and prior demonstration of involvement with ISSM.

Before submitting this application, please ensure that you have reviewed the ISSM Endorsement Policy.
Program Title
Please provide full details of the proposed program

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Program Chair Information
Program Chair's name

First NameLast Name
Email
example@example.com
ISSM member?
Please upload the CV of the Program Chair

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Program Faculty
Please upload a document containing an overview of all faculty members, including their CVs

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Are all faculty members listed above current ISSM members?
Please provide the names of any faculty members who are NOT current ISSM members
Program Location
City
Country
Website
Proposed dates
Please list any local or regional affiliates or other co-branded societies
Estimated # of attendees
Will you agree to show an ISSM promotional slide, provided by the ISSM office, at the beginning of your program?
Should be Empty:

Program Chair Information