EASIM 2022 Summer Application

An application link for the 3rd European Advanced School of Internal Medicine (EASIM) in Riga 2022

Course dates: 2 – 4 July 2022 (Saturday to Monday)

Venue: Radisson Blu Rīdzene Hotel, Riga, Latvia

Target audience: up to 15-20 young Internal Medicine (IM) specialists from European countries in the first few years after completion of postgraduate training in IM but also more experienced internists are welcome to participate.

Course fee package: 550 Euros per person which will include the following - course costs, accommodation in Radisson Blu Rīdzene Hotel for 2 nights (2-4 July 2022), all meals, school facilities, etc. (650 Euros if extra night required, double rooms also available per request).

Webpage: https://easim2022.mozello.lv/
Please, complete and submit the application link for EASIM 2022 as soon as possible by Friday, 24th June 2022, or contact directly the organisers at internisti.lv@gmail.com

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* 1. NAME OF AN APPLICANT:

FAMILY NAME:

FIRST NAME:

MIDDLE NAME (if any):

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* 2. POSTAL ADDRESS AND COUNTRY:

Postal address:

Postal address (2nd line):

COUNTRY:

Do you need a visa invitation (Yes/No):

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* 3. Date of Birth:

Date:

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* 4. Gender (M/F):

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* 5. E-mail:

E-mail 1:

E-mail 2 (alternative) - optional, state N/A if the same:

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* 6. Mobile phone (including country code +XX-xxxx...):

Mobile phone:

Alternative phone - optional, state N/A if the same: