Competition Application Form IMGSOS International Doctors’ Debate Competition – Application Form Name(Required) First Last Gender(Required)MaleFemaleNon-binaryEmail(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What describes your situation best?(Required) You are a medical student. You are a non-specialist medical practitioner. You are a specialist / consultant. Other Medical Specialisation (if applicable):(Required) Medical License Number:(Required) Medical School:(Required) Year of Graduation:(Required) Previous Debate Experience (if any):(Required) Do you have a partner?(Required)YesNoUnsurePartner's Name(Required) First Last Partner's Email(Required) For each of the following areas, please provide details about any relevant experience, training, achievements, or qualifications you might have. If not applicable, write 'N/A'.Leadership & Healthcare Management(Required)Law & Medico-legal Issues(Required)Business & Finance(Required)Ethics & Professional Conduct(Required)Politics & Healthcare Policy(Required)Why are you interested in participating in the IDD competition? (Max 200 words)(Required)Do you agree to IMGSOS terms and conditions and Competition Rules?(Required) I agree.I hereby declare that the information provided above is accurate and true to the best of my knowledge. I understand that any discrepancies might result in disqualification from the IDD competition. I declare that I have read, understood, and agree to the following terms and conditions for participating in the IMGSOS International Doctors’ Debate (IDD) Competition: – Eligibility: I confirm that I meet the specified eligibility criteria for qualified doctors as detailed in the competition guidelines. – Team Formation: I will adhere to the specified team structure and communicate any changes to the organisers for approval. – Content Authenticity: All submissions and arguments I present are my original work. I acknowledge that plagiarism will result in immediate disqualification. – Code of Conduct: I commit to engaging in the competition respectfully and professionally, understanding that misconduct may lead to penalties or disqualification. – Decisions: I accept that all decisions made by the judges and organizers are final. – Data Usage: I consent to my personal data being used solely for competition purposes and not being shared with third parties without my explicit consent. – Prize Allocation: I understand that prizes are, as stated, non-transferable. – Event Changes: I acknowledge that the organisers may change the competition’s dates, format, or rules and will keep me informed of any such changes. – Liabilities: I understand the organizers are not responsible for any technical issues I might experience with the online platform. Recording & Distribution: I consent to the debates being recorded and potentially distributed for promotional or educational purposes. – Termination: I acknowledge that the organisers have the right to terminate the competition or disqualify any participant, including me, if there’s a breach of these terms and conditions. Notes Post your CV(Required)Max. file size: 32 MB.Post your medical license(Required)Max. file size: 32 MB.Post your image for the participants' and winners' announcement pages.(Required)Accepted file types: jpg, jpeg, png, gif.Post other documents if applicableMax. file size: 32 MB.CAPTCHA