V International Pirogov students'
scientific medical conference


 Moscow - 2010

[ APPLICATION FORM ]

At occurrence of problems please contact with The Conference Committee: info@pirogovka.ru
Step 1 - APPLICATION
* - Required fields!

1. Authors:
Last name First name Patronymic (middle) name Status

(fully)

(fully)

(fully)

(student, resident, ...; year of studies; faculty etc.)

* * * *

2. Advisors

Last name First name Patronymic (middle) name Status

(fully)

(fully)

(fully)

(academic degree)

* * * *

3. The full name of the university (college, academy):
*

4. The full name of the department:

*

5. Department’s chairperson:
Last name First name Patronymic (middle) name Status

(fully)

(fully)

(fully)

(academic degree)

* * * *

6. Contact information of one of the authors:

Phone:

 code*

  # *
E-mail: *
Postal address:
Where:   Postal Code: *   Country: *   State:
  Province or Region:   City: *
  Address Line: *
Whom: *

7. Contact information of one of the advisors

Phone:

 code

  #
E-mail: *
Postal address:
Where:   Postal Code:   Country:   State:
  Province or Region:   City:
  Address Line:
Whom: *

8. Section of the Conference:*
Obstetrics and Gynaecology
Internal Diseases
Pediatric surgery
Psychiatry and Clinical Psychology
Medical and Biological Problems
Organization of Health Protection
Pediatrics
Surgery

9. The Form of Participation in the Conference:*
Only publication of the abstract
Publication of the abstract and an oral report
Publication of the abstract and a board poster report

Enter password for cheking application status (not more than 20 symbols)

*