Activity Code: SM/

Title of Meeting

Comments:

Scientific Level of Meeting: Select the Level of the Meeting High Average Low Unable to Judge

Benefit of the activity to the country/region: Select the value of the Meeting Strong Average Weak

Recommendations:

Support Recommended: If so what type of support? Select the level of support Generous Normal Minimal

Support not Recommended:

More information required:

The information required is:

Name of Referee Date

Email of Referee: