XIXth CONGRESS OF THE INTERNATIONAL  ASSOCIATION OF GERONTOLOGY

July 5-9, 2009  Paris, France

 

 

Busse Research Awards

 

Application Form

 

 

Name of Nominee/Applicant: ___________________________________________________________

 

Current Appointment of Nominee/Applicant:______________________________________________

 

Name and Address of Nominator:________________________________________________________

 

Names and Addresses of Seconders:

 

1) _______________________________________           2) _________________________________________

 

 

 

 

 

(TYPE  IN ENGLISH)  Statement of Nominee/Applicant's Research Contributions and

the Significance of those Contributions (not more than 1000 words; use additional sheets as necessary):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                                                                       

 

 

 

 

Statement (continued)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attach:

 

            6 copies of this completed application form

            6 copies of nominee/applicant's curriculum vitae

            1 copy of letters from nominator and seconders

            6 copies of 3 to 5 significant publications/research reports (or summary details)

 

(Deadline - receipt by October 1, 2008)

 

Mail documents to:                                          If you ship by courier service, use the following address:

            Harvey Jay Cohen, M.D., Jury Chair                                   Busse Research Awards

            Busse Research Awards                                           Room 3502, Blue Zone

            Box 3003,  Center for Aging                                               Duke Clinics Building, South

            Duke University Medical Center                             Trent Drive

            Durham  NC   27710    USA                                     Durham, NC 27710  USA