Application Form for the EULAR 2015 Epidemiology Course

Application form for the EULAR 2015 Epidemiology Course

Berlin, July 3-4, 2015

This one and a half day course is aimed at young European rheumatologists/HPR/researchers with some experience in epidemiology/outcomes research. It is a selective course, with competitive admission. Applicants will be selected based on their age (the course is aimed at participants below 40), curriculum vitae andgeographic diversity. Applicants should have at least some previous knowledge of research and of statistics/epidemiology, as this is an advanced course.

The main goal of the course is to increase the interest, knowledge and skills of young researchers in epidemiology and stimulate critical thinking in the design and reading of research studies. Furthermore, the course will also allow young researchers to get together, which will facilitate future collaborations; as well as interact with the prestigious speakers.

The course willfurther focus on interactive learning and practical training, as reflected in the time dedicated for discussion and workshops.

Please note that the course is run entirely in English: a high level of English is mandatory.

The application deadline is 20 April 2015, confirmation of participation will be sent by email before 09 May2015.For more information, please refer to the course description:

Please fill in the form below (where boxes exist they can be checked by double-clicking the box and choosing the option checked)and send it to:

Mrs Gaëlle Notzli, c/o MCI Suisse SA

Phone:+41 22 33 99 628

Fax:+41 22 33 99 601

E-mail:

Please indicate as header:

Epidemiology Course Berlin 2015

GENERAL DATA
Name:
Year of birth:
Gender:
Nationality:
Current position:
Work affiliation, institution and country:
Name of Head of Department:
Telephone:
Email:
Alternative email (optional):
STATISTICAL/EPIDEMIOLOGY KNOWLEDGE
Have you had previous training in statistics and/or epidemiology? Yes No
If yes, please explain (maximum 100 words):
Have you ever done, yourself, a multivariate analysis?
Yes No What´s that?
Which statistical software do you usually use?
Excel SAS Powerpoint Stata SPSS
CURRICULUM VITAE
Main diplomasand year:
Current activities:
% time spent for clinical work:
% time spent for research:
Grants and awards:
International experience:
Are you a member of EMEUNET? Yes No
Have you already participated in a EULAR project or a EULAR workgroup?
Yes No
If yes please explain:
Publications or oral presentations at major congresses (maximum 10 in total; if more than 10 please choose only 10):
WORKSHOP CHOICE- please rate the following workshops according to your order of preference, from 1 (preferred) to 3 (non-preferred); please note that we may not be able to satisfy all workshop preferences.
Workshop / Order of preference
Workshop 1: Network meta-analysis
Workshop 2: Analysing safety data in RCTs
Workshop 3: Calculating and interpreting Quality Adjusted Life Years (QALY)
PERSONAL STATEMENT (please explain here in maximum 100 words, what this course will bring you and why you want to come)
DID YOU APPLY for the EULAR Epidemiology course in previous years? YES NO
If yes, did you attend the EULAR Epidemiology in previous years? YES NO
If yes, in which year did you previously attend the course? 2012 2013 2014
KNOWLEDGE OF THE COURSE - How did you hear about this course?
EMEUNET website, newsletter or email
EMEUNET member, name please:
EULAR website
A senior physician told me about it , name please:
A junior colleague told me about it , name please:
Other, please specify:
BURSARY
Are you applying for a EULAR bursary? Yes No
If yes, please apply online (