Goldrain Preregistrationstudents CC2013

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Eighth course “Clinical Cytogenetics”, Goldrain Castle (BZ), Italy

Goldrain Castle (BZ), Italy, Aug. 24 - 30, 2013

Family Name _______________________ First Name _____________________Birthdates___/___/___ Sex ______ Address for correspondence (professional or private)___________________________City_________________________ Zipcode__________________Country________________________

Telephone (Country code) (Area code) (Number) (_____) (_____) (______________) Fax (Country code) (Area code) (Number) (_____) (_____) (______________) E-mail _________________________

Affiliation (Institute, Laboratory or Hospital) _________________________________________________________

Professional background of the applicant I have completed

Medical School in (year) University studies in (year)

Biology

Others, please specify: Degree obtained:

I have worked in a cytogenetic and/or molecular cytogenetic laboratory Institution, location

Head, supervisor: From to

I have worked in clinical genetics and genetic counselling Institution, location

Head, supervisor From to I am a member of ECA

Yes no

I am a member of another association of cytogeneticists Yes, specify

No

I have already used the ECARUCA database and have an account Yes no

Pre-registration & Accommodation

I wish to register for the course and to reserve a room in the dormitory of the Goldrain Conference

Center or in a nearby hotel. Please put a x in front of your choice.

-

– single room

– double room to be shared with another student

– double room to be shared with a partner not attending the course

Registration fee € 1100.- for a single bed room. € 1000.- for a double bed room. If you want to share

a room with an unknown other participant, you can profit from the lower fee only if there is another

such registered. If you want to bring your partner who does not attend the course, your fee is still €

1100.-, and the partner should pay the additional fee directly at arrival to the staff of the castle; it

would be € 70.- per day for full pension, and less depending on the meals not consumed (for details

see announcement).

The registration fee includes accommodation for six nights, meals for the 24

_{to the 30}

_{of August,}

dinner on the 24

_{of August and breakfast on the 30}

_{of August. It excludes transportation to and}

from Goldrain and a second bed in a double room for non-participants.

Since there is a limited number of participants (50 at maximum, including the lecturers and stuff) and rooms, we recommend that you register at your earliest convenience.

Note: After we have received your pre-registration form, we will inform you about acceptance of your application and send you information about payment of the registration fee. Registration will be accepted only after confirmation by the bank that the registration fee has arrived. Confirmation of registration will be communicated by email to the address above together with further information about travel and other details about the course.

Please, send the pre-registration form via e-mail to [email protected] or