132nd Session of the WHO Executive Board

January 21-29, 2013 Geneva, Switzerland Full Name (Surname, First Name, Middle Name) Age Citizenship Civil Status Passport Date of Issuance Contact Number Name of Medical School Name of Degree Program Year in Medical School Name of NMO Position in NMO (if any) Position in IFMSA (if any) Will I be able to attend the whole meeting (from January 21 to 29, 2013)? (Yes/No) Expected Year of Graduation Date of Birth Place of Birth Passport Number Passport Date of Expiry E-mail Address

APPLICATION FORM FOR THE IFMSA DELEGATION

How do I plan to finance my participation?

Do I need a support letter from IFMSA for my personal fundraising? (Yes/No) Past and current experience relevant to WHO EB meeting topics (3 sentences or less)

What can I contribute to the delegation? (3 sentences or less)

How can my participation contribute to my work in IFMSA? (3 sentences or less)

Three past experience in external representation (attending meetings, conferences, etc.) 1. 2. 3. Three most important achievements 1. 2. 3.

Please submit this form to lwho@ifmsa.org along with the following: Curriculum Vitae Motivational Letter Certification Letter from NMO President Certification Letter from Medical School