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Personal Details
Name: ………………………….………... Surname: ……………….………………..…….
Address: …………………………………..….………………………………..………………
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EU National: Non EU National: (for work permit purposes only)
Home No.: ………………… Day No.: ……….………… Mobile No.: …………….……
E-mail address: ……………….………………………………………….…………………...
Please indicate your availability below.
(Our main examinations take place during January, May, August and November.)
Dates: ………………………………………….………………………………………………
(Please indicate time of year, of month or days of week)
Times: Morning Afternoon (Please circle as appropriate)
Present employment or occupation. ………………………………………….…………
Please give brief details of any relevant experience you have.
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Please provide the names of two people to who we may apply for references.
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Name
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Address
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Tel No
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Position Held
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Name
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Address
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Tel No
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Position Held
The particulars given by me on this application form are true and accurate.
Signature: …………………………………….…….. Date: …………………….…………
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The Registry
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NOTE FOR POST GRADUATE STUDENTS: THIS APPLICATION IS OPEN TO RESEARCH
STUDENTS BUT NOT TAUGHT STUDENTS
Student ID No. (if applicable): .…………………..
WHAT IS THE INTERNATIONAL STROKE PERFUSION IMAGING REGISTRY
公 司 註 冊 處 COMPANIES REGISTRY
20212022 FIFTEENTH JUDICIAL CIRCUIT PROFESSIONAL GUARDIAN REGISTRY FOR THE
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