European Section | The Movement Disorder Society

European Section

MDS-ES Education Fund Application

The MDS-ES recognizes that some countries do not have access to trained Movement Disorder Specialists and are restricted by size and/or resources from establishing a training program.

This program is designed to address the needs of those countries and build rapport with local area societies that have no existing relationship with MDS. It is intended to support three course formats: a stand-alone course, courses conjoined with other local/regional meetings, and consecutive courses.

For further information please contact education@movementdisorders.org.

This form is designed to facilitate the approval, planning, implementation, and evaluation of a continuing medical education activity that will support the MDS educational mission and comply with accreditation requirements.

Applicant Information

Name

Designation (i.e., MD, DO, PhD)

Mailing Address

City

Country

Postal Code

Telephone

Fax

Professional Affiliations

Activity Information

Please complete the table below with as much detail as possible.

Course Title

This course will be presented as:

Stand-alone course/workshop (1-2 days)

Conjoined course with a local/regional meeting

Name of the local/regional meeting

Tentative Location(s)

Tentative Dates(s) (Please provide 3 dates)

Total Amount Requested From MDS (in Euros) €