Application Code :
		
			676-0118-0001
		
			 
	 
	Created Date : Monday, February 12, 2018-17:35 17:35:46Update Date : Monday, February 12, 2018-17:35 17:35:46
	IP Address : 194.225.51.101Submit Date : Monday, February 12, 2018-17:36 17:36:10Email :azari_yam@sina.tums.ac.ir 
	
		Final Form for Planned Trips
	
		
			
				| 
					Name : | 
				
					Aileen | 
			
			
				| 
					Surname : | 
				
					Azari-Yam | 
			
			
				| 
					Position : | 
				
					Assistant professor | 
			
			
				| 
					School/Research Center : | 
				
					School of Medicine | 
			
			
				| 
					E-mail : | 
				
					azari_yam@sina.tums.ac.ir | 
			
			
				| 
					Phone No. : | 
				
					+98 21 64053475 | 
			
			
				| 
					Subject(s) of your planned Trip : | 
				
					Breast cancer | 
			
			
				| 
					From : | 
				
					Monday, August 21, 2017 | 
			
			
				| 
					To : | 
				
					Sunday, August 27, 2017 | 
			
			
				| 
					Name of Destination University : | 
				
					none | 
			
			
				| 
					Name of Destination Country : | 
				
					Canada | 
			
			
				| 
					Report of Planned Trip : | 
				
					oral presentation | 
			
			
				| 
					Achievements of Trips in Faculty/Center : | 
				
					getting to know experts from around the world |