SIR Visiting Professor Application Form

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Please complete the following application to be considered as a SIR International Visiting Professor. As travel opportunities become available, qualified candidates will be notified.

Learn more about this program, including eligibility and requirements at this link www.sirweb.org/giveback. For questions, contact the SIR Giveback team at 703-460-5574 or email Shams Iqbal drshams241@gmail.com

Applicant Contact Information

Title

First Name

Last Name/Surname

Degree (MD, DO, PhD, etc.)

Mailing Practice/Institution and address

Email Address

Phone Number

Upload your CV

Word doc, PDF, etc.

Additional Information

In the space below, please provide a 300 word or less essay that describes your interest in the SIR Visiting Professor program and how you are qualified to be an SIR brand ambassador:

In the space below, please provide a 300 word or less essay of your past overseas experience.

What are your areas of clinical interest and/or expertise?

Below are current opportunities available. Please check all of interest.

Latin AmericaChina

Additional comments

Languages spoken

How did you hear about this SIR Visiting Professor program?

Application Materials

To be considered, you must confirm with the following:

I understand that I must be a member of the Society of Interventional Radiology (SIR).

I understand.

I understand that all documentation (visas) required for legal travel internationally is my responsibility along with booking airfare, including any inter-country flights as discussed with host .

I understand

I understand that I will work directly with host contact to confirm details of itinerary, including the educational content and hospitality arrangements for housing, meals and ground transportation. The Giveback committee will facilitate the process.

I confirm

I understand that I will provide a list of suggested presentations for the host.

I confirm

I understand that I will be presenting a brief overview of SIR and its key opportunities to meeting attendees during your visit (e.g. information on SIR International Membership, SIR Annual Scientific Meeting etc.). An “About SIR” slide deck can be provided to you by SIR..

I confirm

I understand that I will be presenting a brief overview of SIR and its key opportunities to meeting attendees during my visit (e.g. information on SIR International Membership, SIR Annual Scientific Meeting etc.). An “About SIR” slide deck can be provided to you by SIR..

I confirm

Agree to provide a written report at the end of the trip, summarizing the clinical and educational activities, including achieved objectives, difficulties encountered, challenges met, lessons learned and recommendations for future trips. Report must be submitted within 30 days after the trip has concluded. Please send to Dr. Shams Iqbal at drshams241@gmail.com.

I confirm

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