Application for the 2018 East Africa Regional Training in Reconstructive Surgery & Perioperative Care
Please fill out and submit the below application no later than Monday, 2-April to be considered for sponsorship to attend the event.* Applications will be reviewed on a rolling basis.

The three-day long conference will take place July 9-11 at CoRSU Hospital in Kisubi, Uganda.

The 2017 East Africa Regional Training is hosted by Mission: Restore and CoRSU Hospital in partnership with Smile Train and the College of Surgeons of East, Central and Southern Africa (COSECSA).

The training will feature lectures, discussions, workshops, and case presentations on reconstructive surgery & perioperative care, as well as opportunities to network with colleagues from the region.

*Sponsorship includes: Transportation, accommodations and conference fees ($2,000 USD value)
*Partial sponsorship opportunities will also be available
First Name *

Last Name *

What Country & City do you currently live in? *

Age *

Sex *

WhatsApp Contact Number (include area code) *

Please upload a photo of your Passport ID *

Hospital of Employment *

Hospital Level & Type *

Location of Hospital *

What is your position/title? *

How many years of medical school training have you received? *

How many years of post graduate residency have you completed? *

How many years of surgical training have you received? *

What are you MOST interested in receiving training on? *

How often do you perform burn related procedures at your hospital? *

How often do you perform cleft procedures at your hospital? *

How did you hear about the EART 2018 application? *

Have you attended a previous EART? *

Are you available to attend further training July 12-13? *

A select few participants will be chosen for hands-on surgical training following the EART 2018 Conference.

If you would like to be considered for the hands-on surgical training July 12-13, please tell us how you would use these skills at your own hospital. *

Please include any leadership opportunities you have at your hospital for sharing these skills with your colleagues.
Thank you for submitting your application! The Mission: Restore team will be in touch soon.
Powered by Typeform
Powered by Typeform