LASID Junior’s affiliation request – LASID Latin American Society for Immunodeficiencies

Please fill the form bellow. Your request will be reviewed.

Remember you must be younger than 35 or be still in immunology training

Affiliation for Junior Member

Name

First

Last

Gender

Female

Male

Birthdate

Phone

Country

City

Street Adreess

Date of your 35th birth date

Photo ID card

Maximum upload size: 268.44MB

Diploma or degree

Maximum upload size: 268.44MB

Profile picture

Maximum upload size: 268.44MB

Recommendation letter from a LASID member. **It must state that you are in training and the estimated date of completion.

Maximum upload size: 268.44MB