Child Health Foundation The INCLEN Trust Advanced Vaccinology Course 2011 (19th 25th Sept 2011) Venue:

e: The Westin (Sohna-Gurgaon)), NCR Delhi ( visit: www.westin.com/sohna) Name: GUPTA _______________ (Family Name) Age:_52 Yrs. ____________ (Middle Name) ASHOK ___________________ (First Name) Sex: Male

Designation:____Associate Professor __________________________________ Department:____Pediatrics_____________________________________________________ Organizational/Institutional Affiliation: ______SMS Medical College, Jaipur _____ Complete Postal Address with Pin Code:____25, Chetak Marg, M.D. Road, Jaipur- 302004 _____________________________________________________________________________ Phone: (std code) (0141-2606060) ; Mobile: 9829017060 Email id:____dr_ashok_05@hotmail.com____________ Educational Qualification (with Year of Passing):_MD - 1986_____________ ________________________ ________________________ Career Summary (relevant to vaccinology & immunization) Present:__Deputy Executive Director, International Society of Tropical Pediatrics_____________________________________________________ ____________________________________________________________________ Past:_____Incharge Immunisation Clinic, SMS Medical College, Jaipur Fax: (Std code) ( )

Member, Global Immunisation Committee of the IPA Vaccine Trial Conducted Rotateq Vaccine Trial ______________________________________________ ____________________________________________________________________ Memberships/Role in professional organizations: Deputy Executive Director, International Society of Tropical Pediatrics Member Executive, International Pediatric Academic Leaders Association Board Member, Food Allergy & Anaphylaxis Alliance, USA Member, European Academy on Allergy & Clinical Immunology ____________________________________________________________________________ List of Publications (Most recent in last five years with full reference; attach if necessary). 1. Text Book on Pediatric Neurology in Tropics 2. Fundamentals of Sports & Exercise Science Motivation: (How do you think this course may impact on your career, on your institution/ company or on
vaccination strategies at national or regional levels? Indicate why you want to follow this course? Give details on your motivation (s)? This information is essential during the selection process. (Half a page)

Since I am in a teaching Medical College, this training will help me improve vaccination strategies in the institution and with my position as an advisor to the state government on child health issues, this shall also have an impact on the state policies.

Recommendation Letter (Optional)

Last Date: 30th June 2011 Please send your complete applications to: Dr. Vishal Dogra, Course Coordinator; The INCLEN Executive Office, 2nd Floor, F-1/5, Okhla Industrial area, Phase-1, New Delhi- 110020. Tel: +91-11-47730000 +91-11-47730000; Fax: +91-1147730001. E-mail: advac2011@inclentrust.org or vishal@inclentrust.org(For details visit:

www.childhealthfoundation.net ; www.inclentrust.org )