Application for the
November 22-26, 2021
MDC, Berlin
Please fill out this page and submit it by E-mail to Dr.
Suzanne M. Leal or ngs.complex.traits.course@gmail.com. Please simply paste
the form into a body of an e-mail and fill out the form.
First name: _____________________________________________________
Last name: _____________________________________________________
Title:________________________________________________________________
Highest
Degree(s)______________________________________________________
Company / University
__________________________________________________
Department:
__________________________________________________________
Address: _____________________________________________________________
____________________________________________________________________
____________________________________________________________________
City __________________________Country________________________________
Tel. number:
_________________________________________________________
E-mail:
______________________________________________________________
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.
Will you need a visa to enter Germany 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) ______________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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 and at
two nearby hotels with the acceptance letter.
Applications are accepted on a "first come, first served"
basis. Applications will be accepted after the due date; if the course is
filled, you will be placed on a waiting list.
Payments directions: Please send no money now.
Applicants accepted for the course will receive payment instructions.