Application
GENETIC ASSOCIATION COURSE
MDC, Berlin, September 13-17, 2021
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.