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Application form final
- 1. APPLICATION FORM Please complete and return by e-mail to botswanasymposium@gmail.com Or Submit the application form at faculty of science and health science(246) graduate lounge(H014) DATE 5-7 DECEMBER 2012 VENUE; UNIVERSITY OF BOTSWANA SCHOOL OF MEDICINE 1. Participants information Title: _______ Prof. Dr. other: _________________________ Mr Ms Mrs Family name: __________________________________________________________________ First name: ____________________________________________________________________ Institution:___________________________Year of study: _____________________________ Program of study________________________________________________________________ Address: ______________________________________________________________________ City: ________________________________Country: ________________________________ Telephone: ____________________________________________________________________ Email: _______________________________________________________________________
- 2. Accommodation: TICK the appropriate 1. I will need accommodation _________ 2. I will not need accommodation__________ NOTE: Participants will be provided with accommodation at the University of Botswana main campus residential blocks but one is allowed to book their own accommodation at their own expense. MOTIVATIONAL ESSAYS Please answer the following questions in not more than 100 words QUESTION ONE: Whatis your motivation for attending the conference? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ QUESTION TWO: How do you expect to contribute to the conference? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________