Application
GENETIC ASSOCIATION COURSE
MDC, Berlin, September
26-30, 2022
Please
fill out this page and submit it by e-mail to geneticassociation@gmail.com.
Please
simply paste the form into the body of an e-mail and fill it out.
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 ____________________)
Type of Covid
vaccine(s)______________________________________
Dose 1_______________
Dose 2 _________________ Dose 3 _________________
Please submit proof of
COVID vaccination with your application
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.