APPLICATION FORM (DUE BY August 15th

, 2012)

METODOS EN EPIDEMIOLOGÍA CLÍNICA RESPIRATORIA

(MECOR)

MÉTODOS EM EPIDEMIOLOGIA CLÍNICA RESPIRATÓRIA (MECOR)

METHODS IN EPIDEMIOLOGIC, CLINICAL & OPERATIONS

RESEARCH (MECOR)

November 5th

thru 10th

, 2012 – Pelotas, Brasil

LEVEL 1: INTRODUCTION TO CLINICAL RESEARCH

METHODS Is appropriate for clinicians and academicians who are engaged in the clinical practice of

respiratory and sleep medicine, public health, allergy and critical care and wish to improve

their skills in clinical research and investigation. No prior experience with research is needed.

The textbooks used are Epidemiology by Leon Gordis (2nd Edition, Saunders) and Research

Methods for Promotion of Lung Health, published by the Union (previously the International

Union Against Tuberculosis and Lung Disease).

LAST NAME FIRST NAME

NUMBER & STREET ADDRESS APT/SUITE/ROOM

CITY STATE ZIP CODE

COUNTRY HOME TELEPHONE # FAX#

*** Please include country and city codes

ATS MEMBER # (if member) ALAT NUMBER# (if member)

E-MAIL:

Important : MECOR staff COMMUNICATE with applicants by e-email. You **MUST** provide a reliable

email address and check it frequently!! PLEASE WRITE CLEARLY !!

INSTITUTION/HOSPITAL/AGENCY WORK TELEPHONE# DEGREE

LEVEL

1

Requirement : Those of you living in Pelotas area must consider dedicating your full attention to the

course during this week You will not be able to attend to your normal work and family activities. The

course is very intense.

I. CURRICULUM VITAE

Please attach a brief C.V. that describes your training, degrees held, experience, and publications.

II. ESSAY (English only)

Please attach a brief summary (not more than one page) of your interests, responsibilities and experience

(if any) with research, teaching, public health and epidemiology. Include a brief paragraph about your

expectations for this course, your professional goals and indicate how you expect to be able to use the

information you gain in this course in your professional life. Please be as specific as you can.

II. TUITION

Tuition for Introduction to Clinical Research Methods is $200 US. Payment will be due on

September 15th

after you have been notified of your acceptance. Applicants will be notified of their

acceptance within fifteen days of the application deadline. Credit card payments (Visa, MasterCard, and

American Express) are preferred.

Comments or Questions :

_______________________________________________________________________________________

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Please Complete Online Application form with Curriculum Vitae, Essay for receipt by August 15th

, 2012.

(Once received by Application Assistant, applications will be forwarded to Dr.Mara Tellez Rojo, Course

Director, and Dr. Ana Menezes, MECOR LA Director)

Applicants will be notified of the decision by August 31st,

2012

For more information contact:

Gabriela Patiño, Application Assistant

e-mail: gpatinoire@yahoo.com

fax : 54-351-485-3316