Academy Scholarship Application 2018 Question Title * 1. Privacy Policy ConsentInformation collected from you will be added to our database. We may use this for administrative purposes in conducting our work, and for communication with you. In compliance with the GDPR all information will be treated confidentially and will not be shared with any other organisation without your explicit and informed consent. For further information on how we hold and use your personal data please read our Privacy Policy at http://www.eacts.org/home/privacy-policy/ I have read and understand this privacy policy OK Question Title * 2. Last Name OK Question Title * 3. First Name OK Question Title * 4. Email Address OK Question Title * 5. Course Applying For Scholarship To Attend CONGENITAL HEART DISEASE, 13-16 NOVEMBER 2018 OK Question Title * 6. . . . OK Question Title * 7. Date of Birth Date Date OK Question Title * 8. Country of Birth OK Question Title * 9. Main Specialty Cardiac Thoracic Cardio-thoracic Congenital Cardiovascular Other (please specify OK Question Title * 10. Current City of Residence OK Question Title * 11. Current Chief of Department OK Question Title * 12. I am an EACTS Member (you must be a Member to apply) Yes No OK Question Title * 13. EACTS Membership Id Number OK Question Title * 14. I have registered for the course choosing the Scholarship payment option Yes No OK Question Title * 15. CV Please upload a copy of your current CV PDF, DOCX, DOC file types only. Choose File Choose File No file chosen Remove File Please upload a copy of your current CV OK Question Title * 16. Letter of support by the Chief of your unit/department Please upload your letter of support from your Chief of Department PDF, DOCX, DOC file types only. Choose File Choose File No file chosen Remove File Please upload your letter of support from your Chief of Department OK DONE