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Summer University of Pharmacy - application form, 25th - 30th August 2019, Brno, Czech Republic
Welcome to the first step of the Summer University of Pharmacy in Brno!

We are happy to see your interest in pharmacy!

Before you start filling in this application form, make sure that you carefully read the information on the webpage

After the registration period (15th May - 28th June), you will be informed about the selection outcome on Monday, 1st July, via e-mail together with further information on payment details and logistics.

If you have any questions, feel free to contact us at or

Name and Surname *
Your answer
Email address *
Your answer
Date of birth *
Country of residence *
Your answer
Contact person in case of emergency - full name, email, telephone number of the person and relationship to you *
Your answer
Level of English *
Do you have any special food diet or allergy? *
Your answer
Do you have a medical insurance valid in the Czech Republic? (European Health card is valid) *
What is your personal motivation to take part in Summer University of Pharmacy? *
Your answer
Data Processing Agreement *
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