ISN-Programs CME Meeting Application Form
Please note that in order to be eligible for support, a CME meeting is to have a formal scientific program as well as national or intraregional attendance of at least 70-100 expected participants. Classroom type courses for in-house faculty are not considered eligible.
Applications should be received at least 3- 6 months to a year prior to the start of the meeting.
Meeting Name:
Name of Organising Society/Institutions:
Start Date:
End date:
Web-site:
City:
Country:
Contact person:
Tel: +
E-mail address:
Fax: +
Short description of the meeting content: (Please send us an electronic copy of your Scientific Programme.)
What is the purpose of the meeting:
What are the topics of the meeting:
What are the goals and objectives of the meeting:
How do you expect the conference to impact on the field of nephrology in your city, region, or country:
Please describe the measures you will take to encourage the attendance of younger and/or less advantaged colleagues from your
region: (for example: reduced rates, travel grants, etc.)
Suggested ISN speakers and topics – all suggested speakers must be active ISN members and give at least
2 lectures during the CME:
Speaker’s
Name:
Nationality:
Email:
ISN Membership Nr:
*Topic(s):
Speaker’s
Name:
Nationality:
Email:
ISN Membership Nr:
*Topic(s):
Speaker’s
Name:
Nationality:
Email:
ISN Membership Nr:
*Topic(s):
*Choose from here below:
1. Acute Kidney Injury
2. Basic Science
3. Mineral and bone disorders
4. Chronic Kidney Disease
5. Diabetes
6. Electrolytes and acid base balance
7. General Nephrology
8. Global Nephrology
9. Glomerular Disease
10. Haemodialysis
11. Hypertension
12. Nutrition and Hydration
13. Peritoneal Dialysis
14. Systemic Disease
15. Transplantation
16. Interventional Nephrology
17. Renal Pathology
18. Clinical and epidemiological research methodology
19. Infections
Meeting Venue Details (name of centre, address, tel. N°):
Expected n° of delegates
Regions covered:
Are you contemplating a site visit:
Would you like any ISN materials to be sent:
YES
Will you be providing Delegates bags?
YES
NO
NO
Other Sponsors:
SRC Information (only if applicable)
Is this meeting organised in the context of SRC program?
If yes, please provide the following information:
YES
NO
Emerging Center (EC) Name:
EC City and Country:
Supporting Center (SC) Name:
SC City and Country:
Official SRC contact at SC:
E-mail address:
Official SRC contact at EC:
E-mail address:
Who from SRC will be present at the time of CME?
If so, will that person be presenting?
YES
NO
Is the CME combined with a scholarship visit?
YES
NO
PLEASE SEND THIS FORM TO :
ISN Global Operations Center
Rue des Fabriques 1B,
B-1000 Brussels, Belgium
Tel. +32 2 808 04 20, Fax. +32 2 808 44 54
cme@theisn.org