Lorentz Center - Life Sciences with Industry 2017 from 3 Apr 2017 through 7 Apr 2017
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    Life Sciences with Industry 2017
    from 3 Apr 2017 through 7 Apr 2017

 
Family Name (Last Name): 
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Date of Birth:  Type yyyy-mm-dd or Press-> (required for internet access)
Institute (affiliation): 
Address: 
Zip Code: 
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Please check as appropriate 

Almost all Lorentz Center workshops welcome participation of not-invited researchers with an interest in the theme of the workshop, space permitting, while members from the Dutch scientific community are in principle always welcome at the workshops. Please provide below any information concerning your research or background that may be helpful to the organizers in deciding concerning your admission (research field, papers on the subject, collaborations, etc.)

Please state your reasons for wanting to attend the workshop and give a list of recent publications in related areas.
Reasons for attending:  
Publications:  
Current Professional Status:  
Participants are encouraged to stay for the entire workshop week and are expected to stay in the nearby hotel Van der Valk. The organization and companies pay for the hotel rooms. Participants will share a room with another person. Single rooms are available, upon payment of the extra costs.
Arrival date: Type yyyy-mm-dd or Press->
Departure date: Type yyyy-mm-dd or Press->
Hotel needed
My special requirements regarding hotel accommodation,
meat/food are (eg wheel chair access, presence of elevator)
Please indicate which business case you would like to sign up for in order of preference:
First Choice
Second Choice
The organisation aims to connect the participants to their business case of choice, however this may not be possible for everyone.

Privacy policy Lorentz Center
I do not want my name and email address to be kept and used by the Lorentz Center for future mailings for and/or by the Lorentz Center.
I do not want my name to appear on the list of participants on the workshop website.

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