LLL/IPC Registration Form

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REF CODE: STATUS: DATE: Registration form - LLL/IPC Programme (201 _ -201 _ ) COURSES (Acronym) SELECT (x) eman ta zabal zazu Histology & Histopathology of Aquatic Animals (HHAA) Cellular & Molecular Biomarkers (CMB) Research in Marine Environment &Resources (RiMER) Environmental & Marine Genomics (EMG) Universidad Euskal Herriko del País Vasco Unibertsitatea Research in Environmental Contamination & Toxicology (RiECT) Family name: Passpt. N/NIC: First name: Title: Institution/Company: Postal address: Postal code: City: Country: Tln: Fax: e-mail: Additional information: I am currently enrolled in the postgraduate / doctoral programme (name and university): or I was a former postgraduate student at a MER Consortium Partner or Associate (which one?)) From(years): To: and I wish to be offered a waiver (reduced registration fee)1 YES / NO I wish to be elected for a grant (if available) 2 YES / NO I need accommodation2 in the student´s residence YES / NO Comments: 1 Attach a proof of registration in postgraduate/doctoral programmes of MER Consortium Partners or a copy of the MER MSc diploma. 2 You will be contacted (e-mail) by the MER Secretariat PLACE & DATE: SIGNATURE: For registration, this registration form must be completed and sent by e-mail to MER SECRETARIAT ([email protected]) before the deadline indicated in the Course programme, together with a copy of the bank document indicating that a bank transfer with reference to “Course Acronym/Year (UPV/EHU)” has been made to: BANK: BILBAO BIZKAIA KUTXA BRANCH: 0292 UNIVERSIDADES ADDRESS: GRAN VIA 30, EDIFICIO BASKONIA, E-48009 BILBO/BILBAO, BASQUE COUNTRY (SPAIN) ACCOUNT: 2095 0292 98 3239089479 IBAN: ES22 2095 0292 9832 3908 9479 BIC/SWIFT: BASKES 2BXXX MER SECRETARIAT Research Centre For Experimental Marine Biology and Biotechnology (PIE-UPV/EHU) University of the Basque Country (UPV/EHU) Areatza z/g, 48620 Plentzia-Bizkaia, Basque Country (Spain) e-mail: [email protected] www.ehu.es/MER MER.

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