Application

GENETIC ASSOCIATION COURSE

MDC, Berlin, June 24-28, 2019

 

Please fill out this page and submit it by E-mail to Dr. Suzanne M. Leal or to geneticassociation@gmail.com.  

Please simply paste the form into the body of an e-mail and fill out the form.

 

First name: ____________________________________________________

 

Last name: ____________________________________________________

 

Title: ____________________________________________________

 

Company / University __________________________________________________

 

Department: __________________________________________________________

 

Address: ____________________________________________________________

 

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City:________________________________________________________________

 

Country:_____________________________________________________________

 

Tel. number: _________________________________________________________

 

E-mail: _____________________________________________________________

 

Highest degree(s)______________________________________________________

 

Male/Female_________________________________________________________

 

Are you a

________pre-doctoral student _________post-doctoral fellow, ______faculty or _________other (please specify ____________________)

 

 

MDC housing:

 

(___) I wish to use housing at the MDC campus

(___) I will make my own hotel arrangements

 

Note: Due to a limited number of rooms, we cannot guarantee housing at the MDC. We will forward information on how to make reservations at

MDC at a later date – please note that we do not make the reservations for you, this question is asked so we may inform MDC of approximately how many people will be requesting housing.  Rooms are also available at two nearby hotels and information will be emailed to you.

 

Will you need a visa to enter Germany in order to attend the course?  (__) yes (__) no

 

If you will need a visa to attend the course please give the address for the German consulate where you will be applying for a visa.  We will provide you with a letter to aid you with your visa application

 

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Special Interests (e.g. Bipolar Disease, asthma, method development, etc) _____________________________

________________________________________________________________________________________

 

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Applications are accepted on a "first come, first served" basis. Applications will be accepted after the due date; if the course is filled,
 the applicant will be placed on the waiting list.

 

Payments directions: Please send no money now. Applicants accepted for the course will receive payment instructions.