Application Form

ESDaP Courses 2025

Module 3: November 13-14-15

Module 4: December 4-5-6

Diploma Conclusion 14 December

Name - First name

Name

Module 3

Module 4

Specialty and membership

In what specialty are you resident?

Dermatologist

Psychologist

Psychiatrist

Other (accepted on CV)

Resident (copy of the student card)

ESDaP Member

I will pay the registration fees per module (1 module par year is recommended):

400€ as ESDaP member/450 as ESDaP non-member (early bird) before the 1st of May

500€ as ESDaP member/ 550 as ESDaP non member before the 1st of July

I wish to become ESDaP member and I will pay the fees of 75€ (35€ as resident)

600€ as ESDaP Member/650 as ESDaP non members late registration if seats available

Registration and payement through Paypal on the platform https://psychodermatology.moodlecloud.com/

ESDaP Paypal Payment information Paypal psychodermatology diploma

Signature or name

NO refund in case of cancellation

First / Last name

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