Travel Award form; 1993 ISN Congress in Jerusalem

APPLICATION FOR AN INTER NATIONAL SOCIETY OF NEPHROLOGY TRAVEL GRANT The ISN will award travel grants for the XIlth International Congress of Nephrology, Jerusalem, June 13-18, 1993. 1. Applicants must be 35 years of age or under. 2. Preference will be given to presenters, authors or co-authors of a poster or oral presentation. 3. ISN Membership will be taken into consideration but non-members will be considered also. 4. Notice of the award will be sent on April 15, 1993. 5. The grant, if awarded, will be made available in Jerusalem at the time of the congress (successful candidates will be notified where to collect the cheque). FAMILY NAME

FIRST NAME MIDDLE INITIAL

DATE OF BIRTH (must be laterthan June 15,1958)

.

PROFESSIONAL ADDRESS: INSTITUTION

CITY COUNTRY TELEPHONE

FACSIMILE . .

.

PRESENT POSITION

ABSTRACT SUBMITTED: IF SUBMITTED: Include a copy of the abstract form. IF ACCEPTED YOU WILL BE THE PRESENTER OF YOUR ABSTRACT: YES

NO

ISN MEMBER (on 1st January, 1993)

NO

Please complete this form if you wish to apply and send to:

Dr. Claude Amiel Secretary-General, International Society of Nephrology Faculte de Medecine Xavier Bichat 16 Rue Henri Huchard, 75018 Paris, FRANCE

Tel: 33 (1) 46276757

Fax: 33(1)42281564

MUST ARRIVE BEFORE 1ST APRIL 1993

YES