Entog App Form

ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS EUROPEAN MEETING AND EXCHANGE PROGRAMME APPLICATION FORM 2009 Full Name:

____________________________________________________________________

Medical Qualification:__________Date:________________University:_______________________ RCOG registration no: Current grade and year of training:___________________________________________________ Hospital:_________________________________________________________________________ Previous two posts: Grade

Dates

Hospital

Medical Interests:__________________________________________________________________ _________________________________________________________________________________ Involvement in teaching and training:_________________________________________________ _________________________________________________________________________________ Publications, particularly in relation to education and training:___________________________ _________________________________________________________________________________ _________________________________________________________________________________ Please email the above details, together with a letter giving your reasons for wishing to participate in the exchange to: Maud van de Venne and Anni Innamaa, ENTOG Representatives, Trainees Committee, c/o Kay Weir, Secretary to the RCOG Trainees Committee, [email protected]

To reach the College by 20 April 2009 at 14:00 PLEASE DO NOT ENCLOSE ANY OTHER INFORMATION