CAN-Fuel Program

Nomination for Early Career Member

We are now accepting nominations for 20 early-career members to take part in the inaugural meeting on Wednesday, October 23rd, from noon to 18:30 at the Canadian Cardiovascular Congress (CCC) in Montreal.

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* 1. Early Career Member's contact information and demographics:

First Name:

Last Name:

Institution:

Field/Specialty:

Street address:

City:

Province:

Postal Code:

Email address:

Gender:

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* 2. What was your practice start date OR What is your anticipated start date?:

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* 3. Personal letter from the candidate (explaining why they feel they should be part of this inaugural meeting including a brief description of their leadership journey, to date):

PDF, DOCX, DOC file types only.

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* 4. Nominator: Provide the name of a CCS Member who supports your application. Note that CCS office will contact them via email.

Name:

Email address:

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* 5. Abbreviated CV: highlighting leadership activity and/or capacity for leadership in the future:

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Thank you for your submission. Results will be announced by the end of August.