MolMed registration

If you are working in one of the following subthemes
you can subscribe as a member. All others are invited to register as an interested partner of our Post Graduate School. In both cases you are informed about relevant activities of the School.
Please use the form below to register for membership or interested partner of the Molecular Medicine Post Graduate School (MolMed). Your application has to be aurhorized by the board of MolMed. After authorization you can login into the website of MolMed.
Items marked * are obligatory.

*First name:
Prefix:
(tusssenvoegsel)
*Last name:
*Initials:
Title:
*Gender:
 Male:       Female:
*Email address(1):
 (email working address only!)
Email address(2):
Email address(3):
*Organisation:
*Department:
*Room number:
*Street & number:
*ZIP & *city:
*Phone(1):
Phone(2):
Phone(3):
GSM(1)
GSM(2)
Fax(1):
Fax(2):
*I want to be a member:
 Yes:    No: (select No in case you do not meet the mebership criterea)
*I want to be an interested associate:
 Yes:    No: (select Yes in case you are interested but do not meet the member criteria)
*I want to receive MolMed emails only:
Yes:    No: (not a (associate) member but email member)
*Sub theme:
Sub theme:
Sub theme:
Sub theme:
Sub theme:
*Position:
*Supervisor:
Prev. training(1):
Prev. training(2):
Remarks: