FESGE Application form – ESGE Applications

Fellow of ESGE (FESGE) Application form

"*" indicates required fields

Personal information

ESGE Membership ID*

Current uninterrupted membership in ESGE for a period of no less than five years (post Trainee Membership) is required.

Medical Degree*

for example: MD, PhD

Full name*

First Middle Last

Email*

Enter Email Confirm Email

Postal address*

To be used for shipment of the pin and a certificate

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Significant contributions to GI endoscopy as evidenced by one or more of the following

Your scientific and educational contribution to the field of GI endoscopy*

Please describe below or insert N/A if not applicable

Your past and ongoing involvement in ESGE activities*

Please list below, including the name of Committee and / or Working Group and / or Activity, the date of service, and your role. Please insert insert N/A if not applicable.

Do you hold any leadership position within a medical society, other than ESGE?*

Yes

If yes please provide details below*

Documentation

All submitted documents must be in English

Current brief CV with list of publications*

Please include your brief CV with list of publications (1 file, up to 5 pages, PDF format, maximum file size: 2 Mb)

Accepted file types: pdf, Max. file size: 2 MB.

1. Recommendation letter from a current FESGE member*

Please include the recommendation letter No 1. from another FESGE member. (Up to 500 words, 12-point font format: PDF format, maximum file size: 1MB)

Accepted file types: pdf, Max. file size: 1 MB.

2. Recommendation letter from a current FESGE member*

Please include the recommendation letter No 2. from another FESGE member. (Up to 500 words, 12-point font format: PDF format, maximum file size: 1MB)

Accepted file types: pdf, Max. file size: 1 MB.

Billing address

Please provide your billing address if it is different from the postal one inserted above.

Phone

This field is for validation purposes and should be left unchanged.