YOUTH WORKSHOP ON INTELLECTUAL PROPERTY, PUBLIC HEALTH AND ACCESS TO MEDICINES

YOUTH WORKSHOP ON INTELLECTUAL PROPERTY, PUBLIC HEALTH AND ACCESS TO MEDICINES
YOUTH WORKSHOP ON INTELLECTUAL PROPERTY, PUBLIC HEALTH AND ACCESS TO MEDICINES

and

GLOBAL CONGRESS ON INTELLECTUAL PROPERTY AND PUBLIC INTEREST

14 – 22 DECEMBER 2015

NEW DELHI

APPLICATION FORM

PLEASE COMPLETE THIS FORM, ALONG WITH UPLOADING YOUR C.V. ON OR BEFORE 26 OCTOBER 2015. Contact us at globalcongresswkshop2015@gmail.com in case of any queries.

More information on the workshop can be found here.

Please Note the Word limits. These will be taken seriously in the consideration of your application and exceeding the word limit may ultimately impact the acceptance or rejection of your application.
APPLICANT'S DETAILS:
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Gender
Affiliation (if any)
Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Institutional/ Educational/ Professional Address (if any)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Telephone (landline)

Area CodePhone Number
Telephone (mobile)

Area CodePhone Number
Languages spoken
How did you find out about this workshop?
REFERENCES:

Please provide the name, profession or affiliation, address, telephone number and email addresses of two persons who are familiar with your work.

REFEREE 1:
Name of Referee 1

First NameLast Name
Profession/Affiliation if any
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
REFEREE 2:
Name of Referee 2

First NameLast Name
Profession/Affiliation if any
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
HISTORY OF ACTIVISM, IF ANY
If you have been involved in activism related to public health, access to medicines or any other issue, please provide a brief write up (Max: 300 words)
ESSAY QUESTION:
What in your opinion is the most critical issue facing India in relation to intellectual property, public health and access to medicines and why? (MAX: 300 words)
UPLOAD CV:
Upload your CV here

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PLEASE SUBMIT YOUR RESPONSES AND CV ON OR BEFORE 26TH OCTOBER, 2015.
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