Registration

MolMed members can use the easy registration form after login. Click here to login

Please use this form for registering for 'Workshop on Photoshop and Illustrator CS6 for PhD-students and other researchers'.
Items in bold are obligatory.
First name:
Initials:
Prefix:
 (van, de 't, het, etc)
Family name:
Gender:
 Female
Male
Date of birth:
(dd-mm-yyyy)
Department:
Faculty:
University:
Working Address:
 (street)
(number)
  (ZIP (1234AB) )
(City)
(Room number)
(Country)
Phone:
Mobile phone:
Email:
(email working address only!)
Confirm Email:
Function:
Member of MolMed:
Yes   No
Member of MGC:
 Yes   No
Member of NIHES:
 Yes   No
Participant of the MSc I&I programme Yes   No
Participant of the MSc MolMed programme:
 Yes   No
Commercial participant:
 Yes   No
   
Supervisor:
Remarks:
   
I agree with the financial conditions as mentioned on this website and in the program
 
   
  You will receive an e-mail confirmation.
  The data provided is stored in a database.