Application Form

Heinz A. Oertli-Prize

25%

1) Personal information

Surname

First name

Date of Birth (dd/mm/yyyy)

Date

Place of birth (Place, Country)

Nationality

(For Foreign Nationals) Residency in Switzerland since

Private address (Street, No., Postcode, Place, Country)

Future address (in case of imminent move in the near future) (Street, No., Postcode, Place, Country)

Telephone number (mobile)

Telephone number (work, others)

E-mail address (private)

E-mail address (work)

Profession and academic title

Place of work (Clinic/Institution, Street, No., Postcode, Place, Country)

2) Project

Project title

Other groups involved in body of research

Executive summary (min. 5,000, max. 10,000 characters)

10000 characters left

3) Uploads

Hint for all uploads: max. 25MB (per File), allowed file types: PDF, MS-Office, Google-Office, Images and Videos

List of publications

5 most important publications (pdf-reprints) pertaining to submitted work

Additional Documents

4) Submit

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