Course Application
MDC, Berlin, November 10-15, 2019
Please fill out this page and
submit it by E-mail to Dr. Suzanne M. Leal or to ngsmendelian@gmail.com. Please simply paste the form into the body of
an e-mail and fill out the form.
Your First
name____________________________________________________________________________________
Last name__________________________________________________________________________________________
Title______________________________________________________________________________________________
Company / University
___________________________________________________________________________________
Department:
___________________________________________________________________________________________
Address:
______________________________________________________________________________________________
_____________________________________________________________________________________________________
___________________________________________________________________
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.
Deafness, Achromatopsia, Mental Disabilities)
_________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
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.
If you need a visa to attend
the course we will supply you with a letter to submit at the German consulate
to aid you in obtaining a visa
Payments
directions: Please send no money now. Applicants accepted for the course will
receive payment instructions.