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:
____________________________________________________________
____________________________________________________________________
____________________________________________________________________
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
___________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Special
Interests (e.g. Bipolar Disease, asthma, method development, etc) _____________________________
________________________________________________________________________________________
__________________________________________________________________________________________________
________________________________________________________________________________________
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.