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10th ICMM INTERNATIONAL COURSE FOR
HEALTH SUPPORT IN SAHARAN ENVIRONMENT
Tozeur, Tunisia
November 1-5, 2021

POSTPONED FROM 7 TO 11 MARCH 2022

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Candidates are invited to fill this application form and sent it before October 15, 2021 by e-mail
or by fax at: (+216) 71.560.121.
* Fields to fill imperatively
Name*
Surname*
Rank*
Date of Birth*
Position*
Nationality*
Institution*
Address*
Phone*
Fax*
E-mail address*
Need a visa (yes or no)*
Arrival Date*
Time*
Number of Flight*
Departure Date*
Time*
Number of Flight*
Remarks