AMI-CLINIC 2024

* Fields are required

AMI-CLINIC

Candidate (Surname, Name)*

Head of Service (Surname, Name)*

IRBLleida Group leader (Surname, Name)*

Principal Investigator from hosting group (Surname, Name)*

Host Institution*

Dates of the stay*

CVA candidate*

Candidate Data*

Conformity of the Head of Service*

Acceptance of the host institution*

Supporting documentation (academic report, participation in congresses)*

Sick/maternity lift accreditation*

Documents: