International Centre for Infectious Diseases INTERNATIONAL HIGH CONTAINMENT BIOSAFETY WORKSHOP Winnipeg, Manitoba May 15 - 19, 2006 APPLICATION FORM (Please print clearly) Name: ______________________________________________________________ (Mr/Ms/Mrs/Dr) Title: ______________________________________________________________ Organization: _________________________________________________________ Street Address: _______________________________________________________ City: __________________________ Province/State: _________________ Postal/Zip Code: ________________ Country: _______________________ Telephone: _____________________ Facsimile: ______________________ (Include County/Area code) Email: __________________________________________ Tuition Fee $2800.00 CAD Fees are in Canadian dollars and include all costs associated with the training as well as transportation to and from the hotel, lunches and an evening reception dinner. The fees do not include accommodation or travel costs. Information regarding payment of tuition fees will be provided to the selected participants with their acceptance letter. Cancellation Policy: refunds will be given for written requests postmarked no later than February 20,2006, less an administration fee of $75.00. After that date, we regret that no refunds can be issued. Since course participation will be limited, the Workshop Organizing Committee will select suitable participants based on responses to the attached questionnaire. Please include the questionnaire with this application. Important Deadlines: Applicants will have until December 20, 2005, to submit their completed form. Notifications of acceptance will be sent to selected applicants by December 30, 2005. Once advised of acceptance, payment must be received by January 30, 2006. Please mail or fax completed Patti Alexander application form to: Canadian Science Centre for Human and Animal Health C3125 - 1015 Arlington St. Winnipeg, Manitoba, Canada R3E 3P6 Facsimile: (204) 789-5019 CRITERIA In order to provide the highest quality of training, including the opportunity for hands on experience, the participant/instructor ratio is being kept very low with limitations on the number of participants. This is an advanced workshop meant for people with some knowledge and background related to biosafety, but who would benefit from further instruction and hands-on experience. Criteria have therefore been established to ensure that the candidates who would gain the most from this training will be selected. While assessing the candidate’s current level of expertise and the benefit of further training, the Workshop Organizing Committee will strive for representation from different regions of the world, in keeping with the concept of an international workshop. As all portions of the workshop will be conducted in English, including work inside containment, for safety reasons it is important that all participants be fluent in the English language and very comfortable working in it. The International Centre for Infectious Diseases will be conducting other workshops in the future. If you are not accepted at this time, please do not hesitate to apply again. Please answer the following questions on a separate piece of paper and forward it along with your application. 1. How will participation in this workshop help you in your current or future work? 2. What are specific areas of interest that you would like to see addressed as part of the training? Please specify if these are practical or theoretical. 3. Please describe your work experience and familiarity with high containment facilities. Specify if this pertains to BSL3 and/or BSL4. 4. Please list your education and training, as well as any pertinent background information (specify degrees and level of training obtained). 5. Please describe your ability to work in English. 6. Participants should note that this course is physically demanding. Please describe any medical conditions that the instructors should be aware of prior to your entry into containment.
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