Bursary Application

Artery Conference Bursary Application

Title * Title

Forename *

Surname *

Date of birth *

Gender

Male

Female

Job Title *

Organisation *

Address 1 *

Address 2

Address 3

City *

Postcode

Country *

Phone Number (Incl. country code, no spaces)

Email Address *

Please confirm that you are a member of ARTERY Society and paid membership fees if applicable.

I confirm the above

Please enter the title of your abstract submission *

Please upload a copy of your CV *

Maximum upload size: 52.43MB

Please upload the statement of support for your bursary application *

Maximum upload size: 52.43MB

Please provide an outline of the professional benefits you anticipate gaining by attending the ARTERY Conference *