Professional Documents
Culture Documents
Wonca Bursary Application Form
Wonca Bursary Application Form
Please complete in capital letters. Family Name: Given Name: Address: E Mail: Phone: Fax:
To which College / Association do you belong? Address: What is your status? Trainee / Resident Trained Family Doctor
What will be the benefit to you and / or your organisation of attendance at Wonca World 2013? (maximum 200 words)
Why do you wish to receive a Bursary? Why is other funding unavailable or inappropriate? (maximum 50 words)
If this application is successful, we agree to pay for Registration and recommended Accommodation based on appropriate original bills, to a maximum of $1,000. Signed: Name:
Position:
Date: