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.