Public Health InComplex Emergencies

Training Program

Application Form – 2010

March 8-20, 2010

Faculty of Health Sciences

American University of Beirut, Lebanon

Name: / Date of Birth:
Nationality: / Male/Female:
Permanent Mailing Address:
Current Work Address:
Email: / Alternative Email:
Work Telephone no: / Home/Mobile Telephone no:
Fax:

You may attach a resume or CV in place of questions 1-4:

1. Organization/institution where you are employed:

2. Current job title & brief description of duties and responsibilities:

3. Other related emergency public health field experience:

4. Education:

5. English proficiency: / Poor / Fair / Good / Excellent
Comprehending spoken English
Reading Text

6. Please list your expectations from the Course:

7. Would you like to do a presentation? Informal lectures, case studies or slide shows are welcome (maximum 20 minutes, optional evenings). If so, please state your topic here:

8. If there is an agency or organization which will sponsor you for this course, please provide the following information:

Name of sponsoring organization:
Contact Person: / Title:
Address:
Telephone: / Fax:
Email:

How to Apply

It is best to apply electronically. If you have access to this Application Form electronically, save the form as a file on your computer, type in your information, save the file, and email a copy as an attachment to the contact person listed below for the specific course you wish to attend. If you have received this information in printed form, please return by fax or regular postal mail.

Faculty of Health Sciences, AmericanUniversity
of Beirut
Lebanon / AsianDisaster
PreparednessCenter
Thailand / MakerereUniversity
Institute of Public HealthUganda
March 8-20, 2010 / 2010- Date to be announced / 2010- Date to be announced
Ms. Zeina Mohanna
Instructor of PH Practice
Faculty of Health Sciences
AmericanUniversity of Beirut
P.O. BOX 11-0236
Riad El Solh 1107 2020
Beirut, Lebanon
Tel: (961-1) 374 374 Ext. 4627
Fax: (961-1)744 470 (Attn: PHCE)
Email: / Ms. Janette Lauza-UgsangProject Manager
Public Health in Emergencies
AsianDisasterPreparednessCenter
P.O. Box 4 Klong Luang, Pathumthani
12120 Thailand
Tel. (66-2) 516 5900 ext 351
Fax (66-2) 524 5360 / 524 5350
Email: / Ms. Prima Nalubega WasukiraAssistant Registrar
Makerere University IPH
MulagoHospital Complex
P.O. Box7072,
Kampala, Uganda
Tel: (256-41) 543872
Fax: (256-41) 531807
Mob: (256-77) 492941
Email:

Website:
Click on Continuing Education / Website:
Click on Trainings and Workshops / Website:
Click on Upcoming Events
Application Deadline

Applications should be submitted as soon as possible and at least one month before the start of the chosen course. They will be accepted on a rolling basis until the course is full. Course organizers will review applications, and notification of status will be sent as soon as possible. Upon registration and receipt of payment, applicants will receive detailed information concerning pre-arrival reading assignments and logistical details, etc.

Tuition and Cancellation Policy

Tuition for the course is $2,400 which includes course fees, accommodation, all meals, and all reading and reference materials. The tuition includes a non-refundable registration fee of $250.

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