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Registration Form - ETP Nanomedicine General Assembly and Annual Forum 2010

Please complete the form below to register for the ETP Nanomedicine 2010 event. The number of participants is limited, thus access will be granted on a first come first serve basis. Once your registration has been processed you will be notified by email.

* - required fields

Gender *
Title
First Name *
Last Name *
Phone *
E-Mail *
Organisation *
Department
Street *
Postcode *
City *
Country *
I wish to present a project proposal at the event (5 min. presentation, selected proposers will be informed) *
Yes
No
Preliminary Title for the presentation
Abstract (2-3) sentences:
Registration fees *
Member of the ETP Nanomedicine (Free of charge, max. 2 participants per institution)
Non member of the ETP Nanomedicine (300 EUR + 19% VAT)
I will participate in the evening dinner on 14th October *
Additional tickets for the evening event are available upon request.
Yes
No
Payment information * (required if non member)
I want to pay by bank transfer; please send an invoice to my receipt address. (available only for participants from Germany)
Add this code to my invoice:
I want to pay by credit card; The payment is handled externally.