Registration form for Brainstorming III


Early registration before March 31, 2007: Students 30 € other 50 €!

The registration fee after March 31 is 40 € for students (must provide proof of status on arrival to the congress) and 70 € for other participants. The fee includes all coffee and lunch breaks as well as the dinner on friday night.

The registration deadline is June 25, 2007!

Please transfer your overall fee to:

Tierärztliche Hochschule Hannover
Kto. 106 031 230
BLZ 250 500 00 (Nord LB Hannover)
Verwendungszweck: Brainstorming, Auftrag-Nr. 72000027

IBAN-Nr.: DE 62 2505 0000 0106 0312 30
SWIFT-BIC: NOLA DE2H
USTID Nr. DE 233060166

First name*:
Last name*:
Title*:

Are you a student?*

Yes No
Institution*:
Street, no*:
City*:
Postal code*:
Country*:
Telephone*:
In which round table discussion do you want to participate presumably? Plesnila
Sullivan
Dirnagl
Reiter		 Meairs
Wytik
Mendelow
Samii
I will present a poster.*

Yes No
Email*:
Other information:
(Poster abstract,...)
* fields are required.