Summer School Medical Genetics – From Next-Generation Sequencing to Translational Medicine in Oncogenetics Application form
Please fill out all this form and email it to [email protected] no later than July 24, 2017. Incomplete applications may not be considered.
1. Personal information First name: Klicken Sie hier, um Text einzugeben. Last name: Klicken Sie hier, um Text einzugeben. Title: Klicken Sie hier, um Text einzugeben. Employer / University: Klicken Sie hier, um Text einzugeben. Department: Klicken Sie hier, um Text einzugeben. Street, No.: Klicken Sie hier, um Text einzugeben. Postal code, town, country: Klicken Sie hier, um Text einzugeben. (Please provide an address which we can use for the invoice.) Email address: Klicken Sie hier, um Text einzugeben. Qualification: Klicken Sie hier, um Text einzugeben. 2. Registration and fees Core Extended Summer School . All sessions and workshops
. Lunches (MON – WED)
. Dinner (MON)
. All tea & coffee breaks Social event . A boat trip in one of the famous „Stocherkahn“ – the boat type exclusive and native to Tübingen navigated by a long wooden pole
. A 3-course dinner with drinks.
Registration fee 280,- € 345,- € I apply for participation ☐ Core ☐ Extended
3. Research subject / Subject of interest Research subject / subject of interest: Klicken Sie hier, um Text einzugeben.
Motivation to join the course including a brief description of your background and project or research interest (250 words): Klicken Sie hier, um Text einzugeben.
Word count: Klicken Sie hier, um Text einzugeben.
4. Poster abstract Attendance of the Summer School and presentation of a poster will be acknowledged with 3 ECTS credit points. I would like to present a poster: ☐ Yes ☐ No
Poster title: Klicken Sie hier, um Text einzugeben. Author list and affiliation: Klicken Sie hier, um Text einzugeben. Poster abstract (250 words): Klicken Sie hier, um Text einzugeben.
Word count: Klicken Sie hier, um Text einzugeben.
5. CME credit points We will grant 25 CME points (Category A) for physicians for attending the Summer School. Please let us know if they are relevant for you: Klicken Sie hier, um Text einzugeben.
6. Dietary preferences ☐ Non-vegetarian ☐ Vegetarian Dietary or other special requirements: Klicken Sie hier, um Text einzugeben. Allergies: Klicken Sie hier, um Text einzugeben.
7. Payment information Detailed payment information (including the amount due and payment deadline) will be sent after acceptance of the application. Participation is guaranteed only when the full payment is received by July 28, 2017.