Registration form - Short course on GPCRs

Please note that with respect to registration the short course on GPCRs is entirely independent from the GPCR-Helsinki 2010 symposium. Bank account numbers are also different.

Please fill in the form to register; all the fields with a red title and the payment details field in the bottom are obligatory. For students outside of the participating graduate schools, registration is only valid if a corresponding payment is made (please see the fees and payment details below).

REGISTRATION: On-site registration will still be possible at the beginning of the course: Please bring the fee payment as cash or a copy of bank transfert; alternatively, a certificate that you belong to one of the organizing schools.

Personal information

Title:

First name:

Middle name:

Last name:

Current position or job title:

Academic degree:

Institution or company:

Department:

Address:

Zip-code:

City:

Country:

State:

E-mail:

Telephone:

Fax:

Registration fees

Free - student from ISB, VGSB, DDGS or GSPR*

Free - pre-graduate students from University of Helsinki**

120 euros - students from other schools or international PhD students

200 euros - participant from academia

300 euros - participant from industry

*Graduate students: no certificate is needed for the specified graduate school members as we will verify the status with the school coordinators. Please select your graduate school below.

Graduate school:

**Pre-graduate students: The number of seats for pre-graduate students is limited and will be attributed on first come-first served basis. Please supply your student number below.

Pre-graduate student number:

Pre-graduate students from outside the university of Helsinki wishing to register should contact the course coordinator (henri.xhaard [ät] helsinki.fi)

Students from other schools or international PhD students: please specify your school in the field below.

Graduate school:

Country:

Payment details

For Finnish participants:
Bank: Nordea
Account: 166030-77738
Account holder: University of Helsinki
Reference (viite): 991 12365.
IMPORTANT: Please fill in the information field of the payment also the following details:
"Short course on GPCRs 2010"
"Name: " (followed by your full name)

For foreign participants:
Bank: Nordea
IBAN: FI22 1660 3000 0777 38
SWIFT: NDEAFIHH.
Account holder: University of Helsinki
IMPORTANT: Please fill in the information field of the payment also the following details:
"Short course on GPCRs 2010"
"Name: " (followed by your full name)

Comments

Comments or questions:

Proceed

Thank you!